Trach ties, formally known as tracheostomy tube holders, are bands that wrap around a person’s neck to secure a tracheostomy tube in place. This securing mechanism is the primary safeguard against accidental decannulation, the unplanned dislodgement of the tube from the trachea. Decannulation can lead to severe complications, including airway loss, especially if the tract is newly formed. Changing these ties is a clean procedure requiring careful attention to hygiene and technique to maintain airway security and prevent skin irritation.
Preparing for the Trach Tie Change
Before manipulating the existing tube holder, gathering all necessary supplies is important for a smooth procedure. The required items include a new tracheostomy tube holder, scissors (if using fabric ties), clean gloves, and a reliable light source or mirror. Proper positioning is also important; having the person lie flat or semi-reclined allows for better access to the neck and tube flanges.
Careful hand hygiene must be performed before donning clean gloves. It is recommended to have a second person present, particularly for new caregivers, to stabilize the tracheostomy tube during the change. This stabilization prevents movement, which is a common cause of skin trauma or tube dislodgement while the ties are unsecured.
Step-by-Step Guide for Securing the Trach Tube
The foundational rule when changing a tracheostomy tie is that the new holder must be fully secured before the old one is removed. This temporary redundancy provides continuous tube stabilization during the transition. For pre-made Velcro or hook-and-loop holders, thread the narrow fastener tabs through the eyelets, or flanges, located on either side of the tracheostomy tube’s faceplate.
Once threaded through one flange, bring the tie around the back of the neck, keeping the material flat and untwisted against the skin. Thread the opposite end through the second flange. The two ends meet at the back or side of the neck, where they are overlapped and secured using the Velcro fasteners. Excess material can be trimmed, but the fastener should be applied without excessive tension.
If using traditional fabric twill ties, the procedure involves tying a knot. After threading the tie through both flanges, secure the ends with a square knot, which is a flat, non-slipping knot that locks securely. Avoid tying a “granny knot,” as this unstable knot can easily slip. The square knot is formed by crossing one end over and under, and then crossing the same end over and under again in the reverse direction.
The knot should be placed to the side of the neck, rather than directly behind, to prevent pressure injuries. To minimize continuous pressure, alternate the location of the knot with each tie change. Once the new tie is fully secured, the old tie, which was left in place, can be carefully cut with blunt-ended scissors and removed from the opposite side.
Ensuring the Ties are Safe and Secure
Following the attachment of the new holder, an assessment must be performed to confirm the tension is appropriate. The established method for checking proper tightness is the “two-finger rule.” This test involves inserting two fingers comfortably between the secured tie and the person’s neck. If two fingers slide easily beneath the tie, the holder is secure enough to prevent tube movement without restricting circulation or causing discomfort.
A tie that is too loose permits excessive tube movement, potentially damaging the tracheal wall or leading to accidental dislodgement. Conversely, a tie that is too tight can cause skin breakdown, restrict venous return, or press uncomfortably against the trachea. After securing the holder, the skin beneath and around the tie must be visually checked for signs of pinching, redness, or irritation.
The visual confirmation should also include checking the knot or Velcro placement to ensure it is centered and lying flat against the skin. Uneven tension or a bunched-up holder can create pressure points that increase the risk of skin breakdown. This post-procedure check ensures the tube is secured without compromising the integrity of the surrounding skin tissue.
Maintenance and When to Replace Trach Ties
Tracheostomy ties should be changed regularly to maintain cleanliness and prevent skin complications. A common practice is to change fabric ties daily, or immediately if they become excessively damp or visibly soiled with secretions. Fabric ties absorb moisture, which creates a breeding ground for bacteria and increases the risk of skin irritation around the stoma site.
Signs that necessitate an immediate change include fraying material, heavy soiling, or a foul odor. During the tie change procedure, the skin around the neck should be gently cleaned with mild soap and water, then thoroughly patted dry. Maintaining a clean and dry neck area is important for preventing skin breakdown and infection beneath the holder.