Changing a Cuffed Tube
Required materials and equipment:
- Eye protection and gloves
- Bowl filled with clean clear water
- Suction unit
- Suction catheters
- Tracheal dilator
- Tracheal compresses with additional zigzag slit
- Replacement tracheal tube and a tracheal tube of the next smaller size
- Insertion aid/obturator
- Small sink
- Special cleaning towels, special cleaning swabs
- 10 cm3 syringe (for tubes with cuff)
- Cuff pressure monitor (cpm)
- Neck straps
- Lubricant on a water basis
- Tracheal stoma oil, protective skin cream
- Emergency equipment, listed under standard tracheal stoma care
- Waste container
Never use sharp objects when handling cuffed tubes as these could damage the cuff. Use water-soluble lubricant only to lubricate tubes. If you are using a tube with fenestrated opening, the inner cannula is introduced after the tube has been inserted and secured in the tracheal stoma and the obturator has been removed, but before the cuff is inflated.
The new tube can usually be inserted without problems. Alternately, you can insert a new tube of a smaller size. Call your doctor immediately if you have any other problems.
All working steps listed in the protocol below represent the conventional procedure. Under all circumstances, you should observe the manufacturer's instructions, and follow the instructions given by the physician or nursing staff in charge.
- Wash your hands. Put on clean gloves and eye protection.
- Remove the replacement tracheostomy tube from its packaging. Take care not to cause any damage to the cuff, the tubing used to inflate the cuffs, or to the control balloon.
- Remove the inner cannula (if supplied).
- When inserting a tube with an adjustable neck flange, secure it at the appropriate site. (If you are not sure about the distance required, you can use the measuring scale on the old tube that is still in place for orientation.) Important note: Make sure that the neck flange is straightened properly.
- Carefully dry the air feeding line to ensure that no water can enter when inflating the cuff.
- Use a clean dry syringe to inflate the cuff up to the right volume for the leak test. You will find this volume listed in the package leaflet enclosed with the tube. The air volume can be read off the markings on the syringe.
- Place the entire tube, including the air feeding line, in a sterile pan with enough sterile water to cover the parts completely. Check to see if any air bubbles escape that would indicate a leak. (Make sure that no water enters the air feeding line used for blocking.) Important note: Do not use the tube if you detect any air leaks during the leak test!
- Using the syringe, release all the air again. While doing so, push the cuff carefully off the end of the tube in the direction of the neck flange. Make sure that you remove all air. (This makes it easier to insert the tube.)
- Thread the neck strap through one of the openings on the neck flange. If appropriate, insert the obturator in the tube (carry out this step before you insert the tube); have a new tracheal compress ready at hand.
- To make the tube slide in better, coat it with a thin layer of lubricant (on a water basis).
- Place the tube on a sterile surface.
- If necessary, suction off any secretions out of the old tube that have collected above the cuff. Always follow the instructions given to you by your physician or the hospital personnel.
- Using the syringe, release all air from the cuff on the old tube that is still in the throat. Open the neck strap and remove the tube. If you are not able to remove the old tube, consult your doctor. Never apply force!
- In patients with a (non-epithelialized) tracheostomy, insert the new tube immediately; otherwise the stoma could close back up quickly. For such an event, special insertion aids are available.
- Carefully insert the new tube while the patient is inhaling. Advance the tube with an arching motion first towards the back and then downwards. While doing this, insert the tube at an angle and push it with a slight turning movement into a central position. If necessary, the patient should keep their head tilted back. Use the tracheal dilator if appropriate.
- Remove the obturator immediately while holding the tube in place with your fingers.
- Now use the neck strap to fasten the tube in place.
- Insert the new inner cannula, making sure that it is fastened properly. You will find further instructions on how to do this on the package leaflet enclosed with the tube.
- Inflate the cuff to the correct pressure using a cuff pressure monitor (cpm). Your doctor
- will tell what pressure to use. Recommended value: 25 mmHg, do not exceed 30 mmHg.
- Check the cuff pressure using the cuff pressure monitor (cpm).
- Carry out stoma care as usual; perform suctioning once more as required.
- If you have used a one-way product (“single use” product), you must dispose of the old tube. You can use “single-patient use” products several times for the same patient. Clean the product according to the manufacturer's instructions.