Anatomy of the Tracheostomy

1. Outer cannula = tracheostomy tube itself, may or may not have a cuff

            - A hint is that a cuffed tube will have a pilot balloon as pictured below, similar to an endotracheal tube

            - Benefit of a cuffed tube is that the balloon can be inflated and the trach may then be used for mechanical ventilation

2. Inner cannula

            - Removable insert used for cleaning of respiratory secretions

            - Often not present in pediatrics as small diameter to begin with

3. Obturator

            - Used for insertion of tracheostomy to prevent local trauma from sharper edges of tracheostomy tube itself

Pertinent questions:

1. When was the tracheostomy placed?

2. Why it was placed?

3. Who placed it?

4. What type - Size? Cuffed or uncuffed? Manufacturer?

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How to Change a Trach in a Stable Patient

***Note: consult surgeon to change if <7 days old as tract will not be fully matured and there is risk of creating a false passage or collapsing the tract itself***

Equipment:

- Spare tracheostomy tube in patient’s size and a size below

- Suction - both a Yankauer and a smaller suction device that can fit through the stoma

- Tracheostomy ties

- Good lighting

Steps:

- Remove trach (ensure balloon is deflated if cuffed)

- Suction area

- Replace with new trach with obturator inserted

- Remove obturator

- Inflate balloon if cuffed

- Insert inner cannula

- Secure with trach ties (typically come in box with trach tube)

- Verify by passing a suction catheter through trach 

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References:

1. Bryant, C. “Complications of Airway Devices.” Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th Ed. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016.

2. Cumpstey Andrew, Benzie Stuart J, McKechnie Stuart. Tracheostomy management BMJ  2012; 345 :e6016