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How to Clean a Montgomery Cannula

How to Clean a Montgomery Cannula

The Montgomery Tracheal Cannula has been used successfully to treat patients for over twenty-five years. It has proven to be a safe and effective product. However, care must be taken to keep the tube clean and clear of mucous and secretions which, left unattended, could eventually result in partial or complete blockage of the tube. Unlike standard tracheostomy tubes, the Montgomery Tracheal Cannula does not have an inner cannula to remove for cleaning. Therefore, please read and follow the following instructions to clean and care for your Montgomery Tracheal Cannula. If after reading these instructions you have any questions or concerns, please contact your physician's office or Boston Medical Products immediately.

A "tracheal stoma" is the opening in your throat where your tube is placed. Some patients who have a well-established tracheal stoma are comfortable removing the cannula, cleaning it, and replacing it into the tracheal stoma. Other patients leave the cannula in the tracheal stoma at all times and clean it in place. This is a personal choice and one that you must discuss with your physician and feel totally comfortable with. We have provided instructions below for both types of cleaning.

Cleaning the Cannula in Placefigure1.png

Equipment List:

You will need the following equipment to clean your cannula in place. These items should be readily available from your local pharmacy or doctor's office:

Normal saline (salt water)

Hydrogen peroxide

Cotton-tipped applicators ("Q-tips")

Mirror on stand

Light source

Step 1: Set up mirror and light source so that you have a good view of the inside of cannula tube.

Step 2: Before cleaning, remove the plug or speaking valve.

Step 3: Make a solution of one part normal saline and one part hydrogen peroxide in a small container.

Step 4: Dip cotton-tipped applicator in solution and carefully clean the inside of the tube. If you encounter any crusts or excessive mucous, follow "Removing Crusts" instructions below.

Step 5: When inside of cannula is clear, wipe with a clean, dry cotton-tipped applicator to dry inside of tube.

Step 6: Replace plug or speaking valve.

Removing Crusts

Additional equipment required to remove crusts:

Alligator forceps

Suction machine with suction catheter attachment

Step 1: Set up mirror and light source so that you have a good view of the inside of cannula tube.

Step 2: Before cleaning, remove the plug or speaking valve.

Step 3: Set up suction machine.

Step 4: Carefully insert the tip of the suction catheter into the cannula to remove small crusts and/or mucous.

Step 5: If you see larger crusts that cannot be removed using Step 2, carefully insert the alligator forceps into the cannula and remove crusts or mucous plugs (Figure 1).

Step 6: Repeat until cannula is clear. Continue cleaning inside of cannula with solution and applicators as described above until inside of cannula is clean.

Excessive Crust Formation

In rare instances, some patients experience heavy crusting and/or formation of mucous plugs. It is recommended using one or more of the following devices to improve this condition:

Ultrasonic humidifier

Nebulizer treatments

Atomizer treatments

Please check with your physician before using any of these methods. He/she can recommend a specific program based on your individual needs.

Removal and Replacement of the Cannula

CAUTION: Removal and replacement of the cannula should be performed by patients ONLY after being trained by a physician familiar with the device.

Equipment List

You will need the following equipment to clean your cannula after removal. These items should be readily available from your local pharmacy or doctor's office:

Container for soaking the cannula

Mild detergent

Tracheostomy tube brush or pipe cleanersfigure2.png

Normal saline (salt water)

Hydrogen peroxide

Cotton-tipped applicators ("Q-tips")


Step 1: Cannula shown in place with ring washer and plug attached (Figure 2).

Step 2: Cannula is simply removed by pulling it forward. Use a slow, steady pull; do not "yank" it out (Figure 3).

Step 3: Remove any ring washer(s) or plug from the cannula.


Step 1: It is recommended that the cannula user keep two cannulas on hand, so that a clean spare is always available.figure3.png

Step 2: After removal, soak the cannula in a solution of mild detergent and very warm water. This will help loosen any stubborn mucous or crusts inside the tube.

Step 3: Using a tracheostomy tube brush or pipe cleaner, gently scrub the inside of the cannula being careful not to scratch the polished inner surface. Clean the outside of the cannula if needed.

Step 4: Thoroughly rinse the cannula inside and out using warm water to remove all of the detergent.

Step 5: Pat dry outside of cannula. Cotton-tipped applicators can be used to dry the inside if necessary. The cannula may also be air-dried.

Step 6: The cannula is now ready to be replaced into your tracheal stoma or kept as a clean spare.


Step 1: Squeeze the flange (inner end) of the cannula together to form a "point" (Figure 4).figure4.png

Important: make sure the groove along the side of the cannula is facing down (in the "6 o'clock" position).

Step 2: Carefully insert this narrow pointed end of the cannula into your tracheal stoma (Figure 5). Do not push the cannula in too far as this will cause irritation and coughing.

Step 3: Once the cannula is inserted, gently pull the cannula out until you feel the flange "engage" the inside wall of your trachea (Figure 5).

Step 4: Replace the ring washer and plug or speaking valve (if used).

Cleaning Skin Around the Cannula

Depending on the condition of your tracheal stoma, your physician mayrecommend cleaning the skin around your cannula. Please check with your physician to see if this is recommended for you.

Equipment Listfigure5.png

You will need the following equipment to clean the skin around your cannula. These items should be readily available from your local pharmacy or doctor's office:

Normal saline (salt water)

Hydrogen peroxide

4 x 4 gauze

Cotton-tipped applicators ("Q-tips")

Betadine (or equivalent) solution and/or ointment (as prescribed by your physician)

Step 1: Before cleaning the skin, slide the ring washer away from the skin so that you have room to clean around the cannula.

Step 2: Clean skin around cannula with a cotton-tipped applicator saturated in a 1:1 solution of hydrogen peroxide and normal saline.

Step 3: Rinse using 4 x 4 gauze with normal saline and pat dry.

Step 4: Apply Betadine (or equivalent) solution and ointment per physician's orders.

Step 5: Replace ring washer to its position against the skin.

Emergency Steps for Tube Blockage and/or Troubled Breathing

The following steps should be taken if the cannula patient shows any signs of troubled breathing, including:

Noise from the tube

Difficulty speaking

Shallow and fast breathing


Crowing sounds from the throat

Change in skin color to pale or blue

Skin feels cold, but damp to touch

You should:

1. Place palm of hand over the cannula to assess air movement.

2. Listen for equal breath sounds.

3. Make sure the groove in cannula is in the 6 o'clock position; if not, rotate cannula slowly until it is.

4. Look to see if inside of cannula is clear. If not, clean the inside of the cannula as described above.

If these measures are not effective, you should then:

1. Remove the cannula.

2. Call your physician immediately

If after removing the cannula, the situation does not improve,

1. Activate EMS - Dial 911

2. Be sure to inform emergency personnel that there was a cannula in place. Show them the cannula and these instructions.


Replacement accessories (plugs and ring washers) are available. Please call Customer Service at 1-800-433-2674 for information.

Helpful Hints

Plugs and rings are supplied attached to each other. This design allows the ring washer to be used with the plug attached so that the plug is not accidentally lost. However, the external portion of the cannula needs to be trimmed for this to work. Do not attempt to trim the tube yourself. Check with your physician. If you cannot use the plug/ring set in this manner, separate the plug from the ring by cutting with scissors. If necessary, you can use a needle and thread (or dental floss) to create a necklace for the plug.

A convenient accessory holder was included with your cannula. Use it to store one or more spare plug/ring sets.

If you plan to use a Montgomeryâ Speaking Valve, make sure your cannula has been trimmed properly.cannulainplace.png The end of the cannula must be trimmed so that the last ring is "flush"). It is recommended that at least three rings remain after your cannula is trimmed if you use a speaking valve. This will enable you to grasp the tube while attaching the valve.

Monitor the skin around your cannula daily for signs of any redness or swelling. Report any changes to your tracheal stoma to your physician immediately.

Check periodically to confirm that your cannula is positioned correctly. Remember - groove should be in the 6 o'clock position!