NB: First Post Trache change is done by Dr/Team member (ENT).

1. Preparation: Ensure the necessary equipment and items are available:

• Sterile tracheostomy tube (same size and one smaller)
• Sterile water
• Syringe (for cuffed tubes)
• Lubricant
• Tracheostomy ties
• Collar dressing
• PPE (eye protection, mask, sterile glove, apron)
• Lighting
• Suction device
• Lubricant
• Gauze and prescribed O2

Check vital signs especially saturation and confirm the patient is stable, with adequate oxygenation and ventilation. Inform and reassure the patient, explaining the procedure.

Procedure of full tracheostomy change

• Sterile Technique: use PPE and maintain aseptic technique throughout
• Clean the stoma and surrounding area with sterile saline to reduce infection risk
• Suctioning: suction the trachea before tube removal to clear secretions and prevent aspiration
• Tube Removal: deflate the cuff (for cuffed tubes) using a syringe, then carefully remove the old tracheostomy tube
• Tube Insertion: insert the new tracheostomy tube gently but swiftly using lubricant, ensuring proper alignment with the trachea

NB: If coughing occurs during insertion, remove inner cannula, and allow cough to subside. For cuffed tubes, inflate the cuff after insertion.

Securing the Tube: Secure the tube with new tracheostomy ties, ensuring they are tight enough to keep the tube in place but not constricting.

Post-Procedure Monitoring:

• Check for proper placement by place hand in front of trachy to assessing air flow, breath sounds, colour of skin, and oxygen saturation (SpO2)
• If colour changes, encourage patient to breath via mouth and nostrils or connect prescribed O2
• Observe for complications like bleeding, discomfort, or airway obstruction
• Documentation: record the procedure, size of the new tube, patient’s condition, and any complications encountered