How to Change a Cuffless Tracheostomy Tube

A tracheostomy tube—also called a trach (rhymes with “take”) or a trach tube—allows a person to breathe without using his or her nose or mouth. Some tracheostomy tubes have a balloon (cuff) on the end to keep air from reaching the nose and mouth.

A cuffless trach does not have a cuff. Therefore, a person with a cuffless trach tube can cough and speak normally.

When you change a cuffless trach tube, make sure to follow any specific instructions from the person’s health care provider.

Tips

• If available, have a second person helping you (helper).
• If tracheostomy ties are used, it is important to replace them regularly to keep them from getting damaged or dirty.

How to get ready

1. Have all supplies ready and available. These include:
   1. Clean gloves.
   1. A new trach tube and an emergency trach tube. One tube should be the same size as the current tube, and the other tube should be smaller.
   1. Suction equipment.
   1. Rolled-up blanket or towel.
   1. Scissors.
   1. Water-soluble lubricant.
   1. Obturator, if needed.
   1. Twill tape ties or hook-and-loop fastener ties.
   1. Clamp or tweezers.
2. Wash your hands, and have your helper wash his or her hands.
3. Put on clean gloves, and have your helper put on clean gloves.

How to prepare to change the tube

1. Make sure the tip of the new trach tube does not touch any nonsterile surface.
2. If you need to use an obturator, put the obturator in the trach tube.
3. If the trach tube has an inner cannula, remove it and insert the obturator.
4. Suction the trach tube as needed.
5. Have the person tip his or her head back a little. This will make it easier to see the opening in his or her neck (tracheostomy).
6. Place a rolled-up blanket or towel under or behind the person’s shoulders.
7. Give extra oxygen as needed.

How to replace the trach tube

1. Hold the current trach tube securely, and have your helper cut and remove the ties from it.
2. Have your helper place a small amount of water-soluble lubricant on the tip of the new trach tube.
3. When your helper is ready, remove the current trach tube from the person’s neck.
4. Have your helper insert the new trach tube right away. (If you are using an obturator, keep some pressure on the obturator.) The new tube should be put in with the curve pointing downward and following the curve of the opening in the neck. If there is resistance, remove the tube and try again. Do not force the tube.
5. If you are using an obturator, remove it.
6. If the trach tube has an inner cannula, put the cannula into place and lock it.
7. While your helper holds the new tube securely, attach the ventilator tubing or oxygen delivery device to the new trach tube.
8. Secure the trach tube with twill tape ties or hook-and-loop fastener ties.

How to finish the process

1. Throw away any used supplies.
2. Remove your gloves, and have your helper remove his or her gloves.
3. Wash your hands, and have your helper wash his or her hands.