Hello, I'm Dr. Paul Chang, Senior Medical and Practice Advisor for the Home Center Care Institute. Today, I will be demonstrating how to change a tracheostomy tube. Please note that I am not wearing PPE for the video to make it easier for you to hear the instructions. However, you should follow all infection control guidelines and use appropriate personal protective equipment during the visit. This, of course, applies to the current COVID-19 pandemic. You can also consider training caregivers and family members to perform this procedure in case of an emergency. This can help avoid costly and unnecessary visits to the emergency room. Please adhere to your own practice guidelines if you do so. You'll want to first gather the equipment and supplies for the procedure as listed in the course materials. I will now walk you through the procedure step-by-step. Wash hands with soap and water and dry with paper towel. Ideally, position the patient supine or semi-recumbent and at a comfortable height for the provider. The provider should stand on the side of the patient that is most comfortable for the provider in doing this procedure. Make sure there is good lighting available. The patient's neck area should be free of any clothing. If needed, suction the patient prior to the tracheostomy tube change. Place sterile field, usually glove packaging, on a clean table and place the new tracheostomy, obturator, tracheostomy tie, inner cannula, dressing, and water-soluble lubricant on the field. This is the point where you put on gloves, mask, and eye protection. Prior to insertion, examine all components of the new tracheostomy tube for defects and inject air into the cuff to test for leakage. Insert obturator into the tracheostomy tube and put a small amount of water-soluble lubricant on the tip of the tracheostomy tube. And you can set the new tracheostomy tube aside. Remove the tracheostomy tie. as well as the dressing, and clean the area with a clean washcloth if necessary. Prior to removal, deflate the balloon if the current tracheostomy tube is cuffed. If applicable, disconnect the ventilator tubing from the tracheostomy tube or remove oxygen mask over the tracheostomy site. Using a curved motion, remove the old tracheostomy tube and discard. Take a light and examine the tracheostomy tube site for any kind of granulating tissue, ulcer, redness, or debris. Clean away any debris or mucus that might be present near the stoma. Now you're ready to insert a new tube. Now there are two ways we can go about doing this. One way is to use the curved motion directly down into the trachea. Note that there may be mild resistance as the balloon passes through the stoma. Do not advance the tracheostomy tube if there's market resistance is noted. If this occurs, remove the tube, reposition the patient, such as tilting the head back, inspect the tracheostomy site, then attempt again to insert the tube. It may be helpful to rotate the tube 90 degrees, It may be helpful to rotate the tube 90 degrees, then slowly rotate back to a neutral position as the tube is advanced. If unable to insert, the smaller tracheostomy tube should be inserted instead. Remove the obturator once the tracheostomy tube is in place. Note obturator should be available if the tracheostomy tube becomes accidentally dislodged and reinsertion is necessary. Insert the inner cannula into the tracheostomy tube and lock it into place. Usually you feel click as you secure the cannula to the tracheostomy tube. Inflate the tracheostomy tube cuff with the appropriate amount of air. This is typically what the patient caregiver has found to be most comfortable for the patient and preventing any air leak from occurring. Reconnect the ventilator tubing or place oxygen mask back over the tracheostomy tube. Wipe off any mucus or blood surrounding the area with a clean gauze. Secure the new tracheostomy tube with the new tracheostomy tie. Sometimes this is the trickiest part of the procedure because the opening on the neck plate can be small and challenging to find. And again, patient might be gagging and moving because we are irritating the trachea with this procedure. Do not secure the necktie too tightly. You should be able to insert one finger breath underneath the necktie. Place gauze underneath the neck plate of the tracheostomy tube. If needed, suction the patient post-procedure. After the procedure, assess respiratory status, oxygen saturation, and evaluate for any discomfort. Dispose of all used material in a trash can. Document the procedure including the type of the tube, lot number, expiration date. Order a replacement tracheostomy tube for the patient to have at home in case it is needed. Order replacement intercannula for the tracheostomy tube in case it is needed as well. If the provider is unable to insert the tracheostomy tube into the stoma, the following should be attempted. Reposition the patient. Try to insert a smaller size tube into the trachea opening. If the above is not successful, cover the stoma area and place face mask of the manual respiratory resuscitation mask over the patient's nose and mouth and give one breath every five seconds. Call 9-1-1. Begin CPR. Here are some additional considerations. While there are other procedures that can be done by a single provider, the tracheostomy tube change is one where an extra pair of hands is beneficial. The first tracheostomy tube change after initial placement, defined as three to seven days post procedure, should be done in a hospital or other controlled environment due to increased risk of complications. There's currently no consensus recommendation for the frequency of tracheostomy tube changes. However, one study recommends tracheostomy tube change every three months due to biofilm formation on the tracheostomy tube which may affect the structural integrity of the tube. I hope you found this video helpful. Please like, share, and subscribe to my channel. Practicing the procedure will help you gain confidence on how to safely change a tracheostomy tube in the home. Thank you for watching.

tracheostomy tube

procedure

infection control

personal protective equipment

COVID-19 pandemic