PRIOR TO COMMENCEMENT OF THE PROCEDURE IF A DIFFICULT AIRWAY IS ANTICIPATED ENSURE THE PRESENCE OF AN ANAESTHETIST OR OTHER APPROPRIATELY EXPERIENCED PRACTITIONER WHO WILL BE ABLE TO INTUBATE IN THE EVENT OF A FAILED RECANNULATION

or, Click here of instruction (steps 14-21) on changing a tracheostomy tube with the aid of a guidewire or other exchange device.

Click here for instruction (steps 14-20) on changing a tracheotomy without the aid of guidewire or other exchange device

Click here for instructions (steps 1-13) on how to perform a tracheostomy tube change, these instructions are applicable to all pateints who require tracheostomy tube change.

• Dressing pack
• Correct sized and type of tracheostomy tube (there should also be a tracheostomy tube one size smaller within easy reach)
• Tracheal dilators
• Exchange device (gum elastic bougie, guidewire supplied with tracheostomy tube)
• Tracheostomy tube holder
• 10ml syringe for cuffed tube
• Sterile water soluble lubricant
• 0.9% NaCl sachet
• Trachestomy dressing (if required)
• Suction (within easy reach)
• Sterile/clean gloves
• Protective eyewear

 Equipment required for Tracheostomy Tube Change

The procedure for changing any tracheostomy tube is as  follows. A tube exchange device may be used locally in some units – advice can be sought from manufacturers regarding availability.

For emergency tracheostomy tube changes see section on Tracheostomy Emergencies.

NB If any of the above exists this may be an indication that a potential complication is developing and the patient should be reviewed by a competent healthcare practitioner.

• Patient requires ≥ 40% oxygen therapy
• Oxygen saturation of ≤ 95%
• Presence of respiratory distress
• Patient has a known upper airway obstruction
• Patients with a reduced level of consciousness
• Haemodynamic instability
• Known or suspected difficulty in passing a tracheostomy  tube

Contra-indications:

Routine tracheostomy tube changes should not be considered if patients display any of the following without seeking the advice of a competent healthcare practitioner.

• Loss of airway
• Haemorrhage
• Creation of false tract
• Tube insertion into false tract
• Hypoxia
• Cardiovascular instability
• Bronchospasm
• Aspiration
• Pneumothorax

All patients are at risk of the following complications when a tracheostomy tube is changed both as an elective or emergency procedure.

Risk Associated with Changing a Tracheostomy Tube

)Tracheostomy EmergenciesNB Emergency situations e.g. tracheostomy tube occlusion may require the tracheostomy tube to be changed outwith the recommended times (see section on

It is recommended that tracheostomy tubes without an inner lumen should be changed every 5-7 days. Patients with excessive secretions may require more frequent tube changes. The first tube change takes place 3-7 days post surgical tracheostomy. In patients with a percutaneous tracheostomy at least 7 days should pass before the first tracheostomy tube change. Double lumen tracheostomy tubes can remain in place for up to 29 days.

Return to list of contents

next