How to Change a Cuffed Tracheostomy (Trach) Tube

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What is a cuffed tracheostomy (trach) tube?

A tracheostomy (trach) is a small opening that goes through the front of the neck into the windpipe (trachea). This opening helps a person breathe if their airway (breathing passage) has been narrowed or blocked. The opening in the skin over the windpipe is called a stoma. A small plastic tube called a trach tube is placed through the stoma to help the person breathe.

This tube can be cuffed or uncuffed:

A cuffed trach tube has an inflatable cuff around it. The cuff creates a seal to prevent air leaks. It keeps food, liquid, or other materials from entering the airway or lungs.
An uncuffed trach tube does not have an inflatable cuff.

Cuffed tracheostomy (trach) tubes need to be changed regularly. Your child’s respiratory therapist will tell you how often.

You might also need to change the trach tube during an emergency. This might occur when suctioning does not clear the tube and your child struggles to get air in and out. Suctioning is a process to remove mucus from the trach so that your child can breathe easier.

Always use 2 caregivers when changing your child’s trach tube unless it is an emergency.

You can change the trach tube at the same time you clean the trach site and change trach ties. Trach ties are bands that go around the neck to hold the trach tube in place.

Always follow the instructions given by your respiratory therapist. 

Supplies needed to change a cuffed trach tube

Suction kit (contains sterile gloves and suction catheter)
Suction machine  
Towel roll 
New (clean) trach tube
Trach ties 
Sterile water  
2 syringes with blunt tips
Water-soluble lubricant (optional) 
Emergency supplies; always keep emergency supplies with your child and within reach.
2 caregivers

Prepare to change the cuffed trach tube

Supplies for a cuffed trach change — Gather all needed supplies before starting the trach tube change.

Both caregivers must clean their hands with soap and water or use an alcohol-based hand sanitizer.  
Gather and prepare supplies. Always keep emergency supplies within reach when doing routine trach care.
Check that you can inflate the cuff on the new trach tube by using a syringe to push air into it. Be sure to pull out all the air after inflating the cuff.  This will ensure that the cuff inflates correctly before it is inserted.
Pull the correct amount of sterile water into a syringe. Set it aside. Your child’s respiratory therapist will tell you how much water to use. 
Attach new trach ties to the new trach tube. Be careful not to touch the end of the trach tube that will go into your child’s stoma.
Use water-soluble lubricant to clean the end of the trach tube. Then, place it back in the trach package.
Your child may need suctioning before changing the trach to help prevent coughing. Learn how to suction a tracheostomy.
Position your child safely lying down so both caregivers can view and reach the trach and neck area. You can place a towel roll under your child’s shoulders to make it easier to see the trach site.

Remove the old cuffed trach tube

The secondary caregiver will use a pointer finger and middle finger to hold the old trach in place.
The primary caregiver will deflate the old cuff using the empty syringe. If your child has a lot of mucus, you might need to suction the mouth before deflating the cuff. 
The primary caregiver will hold the new trach with an obturator in place at the hub. An obturator is the part of the device that helps guide the trach tube in the airway.
While holding the old trach on your child’s neck, the secondary caregiver will use their other hand to undo the trach ties.  
The primary caregiver will count to 3. When the primary caregiver says 3, the secondary caregiver will remove the old trach.

Place the new cuffed trach tube

In a quick arched forward motion, the primary caregiver will insert the new trach into the stoma. Remove the obturator right away. 
Look, listen, and feel for air moving in and out of your child’s trach. If required, place your child back on oxygen supply or ventilator at this time.

A nurse demonstrates secure trach ties on a mannequin — Make sure trach ties are secure, but not too tight. You should be able to slide a finger between the ties and your child's neck.

Secure trach ties and inflate the cuff

While keeping control of the new trach and the patient’s head, the primary caregiver will lift the head and neck. Then, the secondary caregiver will secure the trach ties together.  
The primary caregiver should not let go of the trach until making sure the trach ties are not too tight or too loose. One finger should fit between the trach tie and the neck.
The primary caregiver will continue to hold the new trach in place. The secondary caregiver will inflate the cuff, using the syringe of sterile water.

After any trach change, monitor your child closely for several minutes. Look for any breathing problems or skin color change.

If you have questions about changing a cuffed trach tube, speak to your child’s respiratory therapist.

When to call your care team

Call your care team if:

The mucus smells foul
Your child looks ill
You have questions about changing the cuffed trach
You have problems placing the same size trach or if you replace it with a smaller size trach

Key points about changing a cuffed trach tube

You must change your child’s trach tube regularly.
Always use 2 caregivers when changing a trach tube.
Follow the process the respiratory therapists taught you to change a cuffed trach tube.
Call your child’s respiratory therapist if you have questions about changing a cuffed trach tube.

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Reviewed: October 2023