Tracheostomy Tube Changes

Definition
The pediatric tracheostomy tube change is removal of the tube from the stoma and replacing it with a clean tracheostomy tube. It must be changed regularly for cleanliness and to prevent mucus build-up.

• The most common interval for routine pediatric tracheostomy tube changes is weekly.
• Cuffed tracheostomy tube changes are usually done less frequently.
• The frequency of tracheostomy tube changes is based on physician orders. 
• Preparation of the child is an important component in a successful trach change. 
• It is not painful, but some children may become anxious prior to the change.
• This might be a good time to distract the child such as having the child’s favorite music playing. 
• To prevent accidental vomiting wait for at least one hour after eating before changing the trach tube.
• Equipment preparation for a tracheostomy tube change includes:
• two trach tubes
•  one the size the child currently uses and one a size smaller  
• manual resuscitation device  and mask 
• suction machine, suction tubing and catheters
• Prepare the new tube with the ties attached (if preferred)
• place the obturator in the tube and make sure it easily moves in and out of the trach tube
• Lubricate the tip with water soluble lubricant.
  

Image retrieved from http://www.health.wa.gov.au/education/tracheostomy/tracheostomy_tubes.cfm

Tracheostomy tube changes are necessary:

• To maintain the integrity of the trach tube,
• To prevent the stoma from shrinking down around the trach tube,
  
• To maintain the skills of the caregiver so they will be more prepared in case of an emergent trach change.