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The University of Chicago Medicine - Comer Children's Hospital

Changing the Tracheostomy Dressings

Tracheostomy Ties

You will need the following supplies:

  • A person to assist you
  • Tracheostomy ties or velcro trach ties
  • Blunt-end bandage scissors
  • Gauze trach dressing (trach sponges)
  • Blanket or towel roll
  • Warm soapy cloth

Follow these steps:

  1. Wash your hands.
  2. Before changing the tracheostomy ties, suction your child. Suctioning will remove the mucus and decreases the chances of coughing which may lead to coughing out the trach tube during the procedure.
  3. Cut the tracheostomy tie long enough to fit twice around the neck and add 3 to 4 extra inches. Or assemble the Velcro trach ties per package instructions.
  4. Place a blanket or towel roll under your child's shoulders. This will extend his or her head backward and allow you access to the tracheostomy ties. Hold your child securely and safely. If your child cooperates, the procedure can be done while your child is sitting up.
  5. Have your assistant stabilize the tracheostomy by holding the phlanges securely to the neck.
  6. Cut the old tracheostomy ties with blunt-end bandage scissors near the knot. Thread the new ties through the hole in the phlange.
  7. If using Velcro ties, remove old Velcro ties and thread the new ties through the phalange.
  8. While your assistant secures the trach, bring your child slightly forward and remove the old tracheostomy ties.
  9. Cleanse the back of the neck with a warm soapy cloth. Then rinse and dry thoroughly.
  10. Bring the new ties to the back of the neck. Make sure the ties lie flat and are not twisted. Thread the ties through the other phalange hole. Tie one square knot. If using Velcro ties, thread the Velcro through the other side of the trach and secure the Velcro per manufacturer
  11. To make sure the ties are tight enough, you should be able to place only one finger between the ties and the neck. If they are too loose or too tight, adjust and check again.

Tracheostomy Tube

Tracheostomy tubes are routinely changed--at least once a week--to provide a clean and open airway. The trach should be changed during the day, before meals or one hour after meals, and preferable after chest therapy and suctioning.

You will need the following supplies:

  • A person to assist you
  • Tracheostomy tube with obturator
  • A smaller size tracheostomy tube set
  • Blunt-end bandage scissors
  • Trach ties or Velcro ties
  • Normal saline
  • Suction equipment and suction kit
  • Ambu bag (attached to oxygen if your child is receiving oxygen)
  • Blanket or towel roll

Follow these steps:

  1. Wash your hands.
  2. Assemble the equipment at the bedside.
  3. Open the package containing the tracheostomy tube. Be careful to only touch the phalanges--keeping the tube sterile. Assemble the tracheostomy by inserting the obturator into the trach tube. Thread the trach tie through one of the holes in the phalanges.
  4. Sterile saline may assist in inserting the trach tube. Pour a small amount of sterile saline in a clean paper cup or squeeze a small amount of lubricant onto the sterile middle of the suction catheter kit. Dip the end of the new trach tube in the lubricant and place the tube back in its holder.
  5. Place your child on his or her back with a blanket or towel roll under the shoulders.
  6. Suction.
  7. Ask your assistant to hold your child securely.
  8. If your child depends on oxygen or mechanical ventilation, provide continuous oxygen or ventilation during the procedure. Keep the ambu bag at the bedside.
  9. Ask your assistant to hold the old trach securely to the neck while you remove the old trach ties.
  10. Pick up the new trach. When you are ready to insert the new trach, have your assistant pull out the old trach. Quickly insert the new trach into the stoma.
  11. Quickly remove the obturator and allow your child to breathe. Administer oxygen/ventilation if your child has this requirement.
  12. Secure the trach ties as above.
  13. Suction if necessary.
  14. Complete the procedure with verbal praise or by hugging your child.

If you are having problems inserting the tube, remember to stay calm. Try again. The tube should slide into place with very little resistance. If after two attempts you are not able to insert the tube, lubricate the tip of the trach tube with saline

If you are still unsuccessful, have your assistant try to insert the tube. If your assistant is unable to insert the tube, try to insert the smaller size trach tube. If you continue to be unsuccessful, take a clean suction catheter and insert it into the stoma about 1 inch. Be sure the catheter is not attached to the suction machine. Hold the catheter in place and do not cut the catheter. Call for medical assistance.

The catheter will help locate the stoma when medical assistance arrives. Stay with your child. Be prepared, you may need to perform CPR until medical assistance arrives.