When Should a Tracheostomy Tube Be Changed?

A tracheostomy is an opening that surgeons make through the front of the neck and into the windpipe (trachea) to keep it open for breathing.

A tracheostomy is an opening that surgeons make through the front of the neck and into the windpipe (trachea). The tracheostomy tube is placed into the opening to keep it open for breathing. A tracheostomy provides an air passage to help breathe when the usual route for breathing is somehow blocked or reduced. 

When health problems require long-term use of a machine (ventilator) to help breathe, a tracheostomy is often needed. In rare cases, an emergency tracheostomy is performed when the airway is suddenly blocked, such as after a severe injury to the face or neck.

A tracheostomy is usually done under general anesthesia, but in emergencies, patients are administered local anesthesia.

The type of procedure depends on why a patient needs a tracheostomy and whether the procedure was planned. There are essentially two options:

• A surgical tracheotomy can be performed in an operating room or a hospital room. The surgeon usually makes a horizontal incision through the skin at the lower part of the front of your neck. The surrounding muscles are carefully pulled back, and a small portion of the thyroid gland is cut, exposing the windpipe (trachea). At a specific spot on your windpipe near the base of your neck, the surgeon creates a tracheostomy hole.
• A minimally invasive tracheotomy (percutaneous tracheotomy) is typically performed in a hospital room. The doctor makes a small incision near the base of the front of the neck. A special lens is fed through the mouth so that the surgeon can view the inside of the throat. Using this view of the throat, the surgeon guides a needle into the windpipe to create the tracheostomy hole, then expands it to the appropriate size for the tube.

For both the procedures, the surgeon inserts a tracheostomy tube into the hole. A neck strap attached to the faceplate of the tube keeps it from slipping out of the hole, and temporary sutures can be used to secure the faceplate to the skin of your neck.

Usually, the surgeons will monitor the healing for several days after the tracheostomy. The initial tube that was placed at the time of surgery will be changed to a new tube after and between 10 and 14 days following the surgery, depending on the complications and circumstances.

The tracheostomy tube may need to be changed if it comes out or after 10 days of regular change.

If the tracheostomy tube plugs out, healthcare providers use suction to remove secretions and then gently slide the same tracheostomy tube back into the place. The tube is usually secured and tied.

Equipment required for changing a tracheostomy tube include the following:

• Clean and backup tracheostomy tube or new tracheostomy tube
• Emergency size (smaller) tracheostomy tube is sometimes needed
• Tracheostomy ties
• Scissors
• Rolled towel or blanket
• Soap, warm water, and two soft cloths
• Saline
• Ambu bag
• Tracheostomy dressing 
• Water-soluble lubricant 

Changing the tracheostomy tube

• Healthcare providers usually examine the new tracheostomy tube for cracks, ridges, or any problems. 
• The patient may be placed in a well-lit area with a rolled towel under the shoulders to slightly extend the neck.
• Ties are removed while the tracheostomy tube is secure in place. 
• The wound is cleaned with one cloth and the neck with another cloth using soap and water.
• The area is left to dry for a few minutes.
• Usually, the tracheostomy tube is pulled out in a curving motion. 
• Two fingers are used to keep the wound open, and a new tracheostomy tube is inserted in curved motions while the patient’s chin is up.
• If the tracheostomy tube does not go in easily, the patient’s head and neck are repositioned.
• The tracheostomy tube is secured and tied subsequently.
• Suction is performed, and the patient will start breathing with a new tube.

Every surgical procedure carries the risk of infection and excessive bleeding. Below are a few common risks involved in a tracheostomy procedure:

• If the tracheostomy tube is blocked, the patient may become breathless, which is an emergency condition requiring further changes or emergency surgery.
• Damage to the thyroid gland in the neck
• Damage to the larynx (voice box) or airway, resulting in a permanent change in voice (rare)
• Lung collapse
• Airway obstruction and aspiration of secretions
• Air trapping in the surrounding tissues or chest. In rare situations, a chest tube may be required.
• Impaired swallowing and vocal function