Changing cleaning tracheostomy tube | Patient Education | UC Davis Children's Hospital

To change the tracheostomy tube, it is important to have your supplies ready:

• Suction machine and catheter
• Clean tracheostomy tube with obturator in place
• Size smaller tracheostomy tube with obturator in place
• Clean tracheostomy collar
• Scissors
• Foam dressing cut in the shape of a bib
• Ambu bag or self-inflating resuscitation bag
• Pulse oximeter monitor and probe
• Sterile water or lubricant
• Rolled towel to place under the shoulder blades to extend neck
• Phone (mobile or landline)

Changing the tracheostomy tube is always a two-person job.

If your child has a tracheostomy with a cuff, which is a balloon at the end of the tube, you will also need an empty syringe for deflating the cuff before removing it, and placing either air or sterile water (depending on the type of tracheostomy tube used) back into the cuff after placing it into the neck opening.

A wet baby wash cloth with mild soap and tap water can be used to clean around the neck under the tracheostomy collar before removing the old tracheostomy.

Note: It is important to keep the new tracheostomy tube clean. To help with this, set up a clean area for your supplies. In the clean area, squeeze some lubricating jelly onto a sterile gauze pad that you can dip the clean tracheostomy tube into if needed. You can also use sterile water.

Steps to change the tracheostomy tube:

1. Position: For infants, place a rolled towel under shoulder blades to better see the Older children can be in whatever position is comfortable.
   • Restraining with blankets is not advised
2. Suction if needed
3. Person 1: Keeping the new tracheostomy tube with obturator in place clean, attach one side of the clean tracheostomy collar to the tracheostomy tube. Add lubrication or sterile water to the tip of the tube. Set it back down on the clean area.
4. Person 2: Hold old tracheostomy tube in place with two fingers on the faceplate.
5. Person 1: Remove the old tracheostomy tube collar from one side of the tracheostomy tube.
6. Person 2: Position hand under infant’s jaw being careful to only put pressure on the jawbone. Count to 3 and remove old tube.
7. Breathe, you have a minute.
8. Person 1: Pick up the new clean tracheostomy tube with the obturator in place.
9. Person 1: Insert the new tracheostomy tube from a side angle, rotating into correct position while pushing it further into the neck opening (right handed rotate counter-clockwise, left handed rotate clockwise).
   • If there is any resistance, do not keep pushing. Instead, remove the tracheostomy tube, look closely at the tube and neck opening, and try again.
   • A cuffed tube will have mild resistance, this is expected.
10. Person 1: Once the tracheostomy tube is in place, hold the new tracheostomy tube in place with two fingers on the faceplate, and remove the obturator.
    • Airflow will be blocked by the obturator while it is still inside the tracheostomy tube.
11. Person 2: Secure the new clean tracheostomy collar.
    • Sit the child up to check how snug the tracheostomy collar is. You should be able to fit one pinky finger between the tracheostomy collar and the skin on the right side, left side, and back of the neck.

Cleaning the tracheotomy tube

Shiley

Shiley tracheostomy tubes are meant to be used once and thrown away, also known as “single-use only”. For example, if your child has tracheostomy tube changes weekly, then you would throw out the old tube every time a new one is placed. Do not re-sterilize your Shiley tube or attempt to clean it in boiling hot water.

Please contact your DME company every month to confirm your next shipment date and update your current address and phone number.

Bivona and Portex

Bivona and Portex tracheostomy tubes are meant to be cleaned and reused. For neonatal and pediatric tubes it can be cleaned and reused up to five times. For adult tracheostomy tubes it can be cleaned and reused up to ten times.

Supplies needed for cleaning the tracheostomy tube:

• Mild, fragrance-free, clear dishwashing soap
• 2 deep trays or bowls
• Clean plastic storage bag
• Pipe cleaner or soft-bristled brush

Steps for cleaning the tracheostomy tube:

1. Wash hands with soap and water.
2. Set up supplies.
3. Soak tube and obturator in the first tray with distilled water and clear dish soap. Do NOT use vinegar or hydrogen peroxide.
4. Gently wash the inside and outside of the tube using a pipe cleaner or soft bristled brush. Be careful! Too much scrubbing, scraping, or stretching may damage the tube.
5. Rinse the tube with distilled water and place in the second tray.
6. Gently wash the obturator with distilled water and detergent as described in step 3.
7. Rinse the obturator with distilled water and place in the second tray.
8. Pour rapidly boiling hot water over the tube and obturator in the second Allow them to soak for a minimum of 15 minutes.
9. Once cool, remove the tube and obturator from the water, holding the tube by the neck faceplate and the obturator by its handle.
10. Inspect the tube prior to use. Do not use a tube that is cut or damaged.
11. Allow tube and obturator to air dry completely. Once dry, store in a clean plastic bag.

Cleaning the inner cannula

Supplies needed for cleaning the inner cannula:

• Mild, fragrance-free, clear dishwashing soap
• 2 deep trays or bowls
• Clean plastic storage bag
• Pipe cleaner or soft-bristled brush

Steps for cleaning the inner cannula:

1. Wash hands with soap and water.
2. Set up supplies.
3. Soak inner cannula in the first tray with distilled water and clear dish soap. Do NOT use vinegar or hydrogen peroxide.
4. Gently wash the inside and outside of the inner cannula using a pipe cleaner or soft bristled brush. Be careful! Too much scrubbing, scraping, or stretching may damage the tube.
5. Rinse the inner cannula with distilled water and place in second tray.
6. Pour rapidly boiling hot water over the inner cannula in second tray. Allow it to soak for a minimum of 15 minutes.
7. Once cool, remove the inner cannula from the water, holding the inner cannula by the head at the connector site. Don’t touch the part of the cannula that will be going inside the tracheostomy tube.
8. Inspect the inner cannula prior to use. Do not use an inner cannula that is cut or damaged.
9. Allow inner cannula to air dry completely. Once dry, store in clean plastic bag.