Changing a Cuffless Tube
Required materials and equipment:
- Eye protection and sterile gloves
- Clean bowl filled with an adequate amount of clear, clean 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
- Neck straps
- Lubricant on a water basis
- Tracheal stoma oil, protective skin cream
- Emergency equipment, listed under standard tracheal stoma care
- Waste container
The new tube can usually be inserted withoutany problems. Alternately, you can insert a newtube of a smaller size. Call your doctor immediately,whenever you have any problems.
- Wash your hands. Put on sterile gloves and eye protection.
- Take the replacement tracheostomy tube out of its packaging.
- 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!
- 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 clean smooth surface.
- If necessary, suction off any secretions that have collected. Always follow the instructions given to you by your physician or the hospital personnel.
- Loosen the neck strap and remove the old 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 a 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.