How to Change and Clean your childs Cuffless Tracheostomy Tube

A tracheostomy tube or trach tube is a tube that is surgically placed into the airway (trachea) to help with breathing. There are several types of trach tubes. Older children may have a tube with an inner removable tube (cannula) and an inflatable cuff.

Younger children require only a simple tube without a cannula or cuff (cuffless). Some tubes are used once and thrown away (disposable). Other tubes can be cleaned and reused. Your child may need a tube change every week or every few weeks.

Ask your child’s health care provider how often the tube should be changed. You may also need to change the tube if it gets blocked by mucus and is hard to suction.

These are general guidelines. Your child’s health care provider will show you how to clean and change the trach tube before you leave the hospital. It is recommended that two people work together to change the tube. You and your family members should learn:

• How to suction, clean, and change the tube.
• How to care for your child’s skin.
• How to recognize and fix problems.
• When to call for emergency help.

Supplies needed:

Before changing the trach tube, make sure you have someone to help you. Have these supplies ready:

• All suctioning equipment.
• A new or clean replacement tube. Ask your health care provider how long you can use the tube before you need a new one.
• An extra tube that is one size smaller than your child’s usual tube (in case the larger size is not easy to insert).
• A basin of warm, soapy water.
• A washcloth or clean gauze pads.
• Cotton-tipped applicators.
• Clean replacement ties.
• Scissors.
• Lubricant.
• A rolled up towel or blanket.
• Self-inflating bag.

Follow these instructions at home to change your child’s trach tube:

Before changing the trach tube

1. Plan to change the tube before your child eats, or at least 2 hours after eating.
2. Have two people present and prepared.
3. Wash your hands with soap and water. Dry your hands.
4. Attach the ties to the replacement tube.
5. Have your child lie down flat, and place the rolled towel or blanket under your child’s shoulders.

Changing the trach tube

1. Clean the skin with a cloth or gauze dipped in the warm soapy water. Use a cotton-tipped applicator to remove any sticky mucus. Inspect the skin around the tube site for any signs of redness, irritation, or skin breakdown.
2. Have one person cut or unfasten the ties of the tube and hold it in place.
3. Have the other person moisten the tip of the replacement tube with the lubricant. If the replacement tube comes with a guide (obturator), make sure it is in place inside the tube.
4. When the replacement tube is ready, the person holding the old tube in place takes the new lubricated tube.
5. Remove the old tube and guide the new tube gently into the opening, following the curve of the tube. Do not force it. Remove the obturator as soon as the tube is in place.
6. If you are unable to insert the tube without forcing it, remove it. Repeat the procedure with the smaller tube.
7. Feel for air passing through the tube with your finger. Listen for breathing sounds coming through the tube.
8. Changing the tube may cause coughing and mucus secretions. Wipe away the secretions or suction the tube if needed.
9. Tie or fasten the new tube in place. Make sure the ties are secure. Leave just enough room to insert one finger under the ties.

After changing the trach tube

1. Provide oxygen with a self-inflating bag if told by your health care provider.
2. Observe your child’s breathing for a few minutes to make sure your child is breathing easily.
3. Do one of the following, depending on what kind of tube your child has:
   1. Dispose of the old tube, if you have a disposable tube.
   1. Clean the old tube, if you have a reusable one. To do this:
      1. Clean the tube with warm, soapy water.
      1. Rinse with clean water.
      1. Let it dry on a clean surface.
      1. Store tube in a clean container.

Contact a health care provider if:

• You have any questions about how to care for your child’s trach tube site.
• You do not have anyone to help you change your child’s tube.
• Your child has a fever.
• Your child has coughing or a change in normal breathing pattern.
• Your child’s mucus is discolored or has an odor.
• The skin around the tube site is red, tender, or weepy.
• You needed to replace your child’s tube with a smaller size.

Get help right away if:

• Your child’s tube comes out and you cannot replace it.
• Your child is struggling to breathe. This may include rapid breathing, flared nostrils, noisy breathing, clammy skin, restlessness, or blue lips.
• Your child has bright red blood coming from the tracheostomy.
• Your child chokes after eating.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• Learn how to change and clean your child’s cuffless tracheostomy tube before your child leaves the hospital.
• Ask your child’s health care provider how often the tube should be changed.
• Before changing the tube, make sure you have someone to help you. Make sure you have all your supplies ready.
• Contact your child’s health care provider if you have any questions or problems changing the tube, or if your child has any signs of infection or a change in breathing.
• Call 911 if your child’s tube comes out and you can’t get it back in or if your child has trouble breathing.