Procedure for Changing a Cuffed Tracheostomy Tube

Preparation

The American Thoracic Society recommends gathering all necessary supplies before beginning the procedure, including a new tracheostomy tube of current size with ties in place, one tracheostomy tube one size smaller with ties in place, obturator, suction equipment, shoulder roll, scissors, and resuscitation equipment 1, 2
The American College of Chest Physicians suggests checking the integrity and flexibility of the new tube and verifying cuff integrity before proceeding 2
Positioning the patient with neck in slight extension using a small roll under the shoulders is recommended to optimize access to the stoma 1, 2
Placing the obturator in the new tube, if used, is a necessary step 2

Suctioning the current tracheostomy tube to clear secretions before removal is a crucial step, as recommended by the American Association for Respiratory Care 1, 2
Deflating the cuff of the current tube is necessary before removal, according to the American Thoracic Society 1, 2
Cutting strings/detaching ties securing the current tube is a required step, as suggested by the American College of Chest Physicians 1, 2
Removing the old tube in an upward and outward arc is the recommended technique, according to the American Association for Respiratory Care 1, 2
Inserting the new tube in a downward, inward arc following the natural curve of the airway is the suggested method, as recommended by the American Thoracic Society 1, 2
Immediately removing the obturator, if used, is a necessary step, according to the American College of Chest Physicians 2
Repositioning the patient to neutral position by removing the shoulder roll is recommended, as suggested by the American Association for Respiratory Care 2
Securing the ties to prevent accidental dislodgement is a crucial step, according to the American Thoracic Society 1, 2
Inflating the cuff if needed for ventilation or to prevent aspiration is a necessary step, as recommended by the American College of Chest Physicians 3, 2

Understanding the difference between high-volume/low-pressure cuffs and low-volume/high-pressure cuffs is essential, as suggested by the American Association for Respiratory Care 3, 4
Maintaining cuff pressures below 20 cm H₂O to prevent decreased perfusion of airway epithelium is recommended for low-pressure/high-volume cuffs, according to the American Thoracic Society 3, 4, 5
Using minimal leak technique or minimal occlusion technique while still monitoring cuff pressure is suggested for patients on mechanical ventilation, as recommended by the American College of Chest Physicians 3, 4, 5
Ensuring the maximum diameter of the tracheostomy tube with cuff inflated remains smaller than the minimum tracheal diameter is necessary for low-volume/high-pressure cuffs, according to the American Association for Respiratory Care 4, 5
Following manufacturer recommendations for whether air or liquid should be used for cuff inflation is recommended, as suggested by the American Thoracic Society 4, 5

Having two trained adults present for tube changes, especially in home settings, is ideal, according to the American Association for Respiratory Care 1, 2
Having emergency equipment readily available, including suction equipment and a manual resuscitation bag, is essential, as recommended by the American Thoracic Society 1, 2
Keeping a tracheostomy tube one size smaller available in case the current size cannot be reinserted is a necessary precaution, as suggested by the American College of Chest Physicians 1, 2
Using a suction catheter to guide the new tube through the stoma into the tract if difficulty is encountered during insertion is a recommended technique, according to the American Association for Respiratory Care 1, 2
Never attempting vigorous ventilation through a potentially displaced tube, as this can cause surgical emphysema, is a crucial safety measure, as recommended by the American Society of Anesthesiologists 6, 7

Not forcing the tube if resistance is met during insertion, as this may create a false passage, is a necessary precaution, according to the American Society of Anesthesiologists 6, 7
Using a suction catheter to confirm proper placement in the trachea before attempting ventilation if unable to pass the tube is a recommended technique, as suggested by the American Association for Respiratory Care 6, 7
Attempting insertion with a smaller size tube if the tube cannot be reinserted is a necessary step, according to the American Thoracic Society 1, 2
Removing the tracheostomy tube and applying oxygen to both the stoma and face while awaiting expert assistance in case of complete obstruction or displacement is a crucial safety measure, as recommended by the American Society of Anesthesiologists 6, 7

Confirming proper placement by observing chest rise, breath sounds, and patient comfort is essential, according to the American Association for Respiratory Care 1
Ensuring the cuff is properly inflated if needed for ventilation or aspiration prevention is a necessary step, as recommended by the American College of Chest Physicians 3, 4
Securing the tube with ties to prevent accidental dislodgement is a crucial step, according to the American Thoracic Society 1, 2
Maintaining proper skin care around the stoma to prevent infection and pressure necrosis is essential, as suggested by the American Association for Respiratory Care 1, 2