*THIS PROCEDURE IS TYPICALLY PERFORMED BY A REGISTERED NURSE
The use of this procedure guideline assumes that the registered nurse has the nursing education and skills to perform this task. This procedure guideline does not replace nursing clinical judgment.
This procedure is a general guideline and as this is a complex procedure for the school setting, the school nurse should communicate with the student’s parents/guardians and health care providers to determine how the procedure should be performed.
Considerations:
- This procedure should be encouraged to be done at home; however the school nurse should know how to do this procedure if it is necessary to do at school.
- When caring for a student who has a tracheostomy, the school nurse should always know the reason for the tracheostomy, the student’s underlying health conditions and whether the student needs the tracheostomy to breathe.
- Attempt to provide the student with as much privacy as possible, given the urgency of the situation
- Should always have “GO BAG” (Emergency Travel Bag) accessible when completing any tracheostomy procedure
- The school nurse should establish a schedule to systematically check the “GO BAG” to ensure all the necessary supplies are available, not expired, and are in working condition
- Two people should be present during the procedure in the event of accidental decannulization
- Some children have disposable inner cannulas and do not need to re-clean and reuse their inner cannula, if the child does not have a spare inner cannula in the emergency travel bag, their inner cannula should be cleaned and re-used
- Follow the student’s Individualized Healthcare Plan and health care provider’s orders regarding what solutions to use to clean the inner cannula. Some references indicate to use mild, fragrance-free, clear dishwashing soap, others state to use equal parts hydrogen peroxide and water.
Supplies:
“GO BAG” (Emergency Travel Bag) Equipment:
The essential equipment to be kept with the student at all times is as follows:
- gloves
- portable oxygen (if ordered) with appropriate sized Ambu-bag
- appropriate size Ambu-bag facemask (for emergencies when unable to reinsert a new tracheostomy tube
- portable suction machine that can operate with battery or electricity
- battery should have a full charge
- sterile suction catheters
- sterile saline vials
- water-based lubricant
- distilled or sterile water
- 4×4 gauze
- split gauze dressing, if student uses
- unscented and dye free soap
- syringe, if needed for tracheostomy tube cuff
- sterile water for cuffed trach filled with water
- two spare tracheostomy tubes- one the size the student currently uses and one that is a size smaller in the event that the tube needs to be changed and there is difficulty passing it through the stoma
- obturator, if applicable
- spare tracheostomy ties
- blunt scissors
- emergency phone numbers
- pulse oximeter — may be optional if student is not on oxygen or mechanical ventilation
Additional needed supplies:
- Student’s individual healthcare plan/Healthcare provider’s order
- Parent/guardian authorization form
- Stethoscope
- Sterile water, if ordered
- Tap water
- Hydrogen peroxide, if ordered
- Mild, fragrance free dish soap, if ordered
- Sterile pipe cleaners
- Basin for cleaning
- Personal protective equipment
- gloves
- goggles
- mask
Procedure for Changing Inner Cannula:
- Assembles supplies and place on a clean surface
- Review student’s individual health plan/health care provider’s order
- Ensure proper documentation of parent/guardian authorization to perform this procedure
- Position student providing as much privacy as possible
- Explain the procedure at a level the student will understand
- Wash hands
- Assess student’s respiratory status to ensure it is appropriate to change tracheostomy cannula at this time
- Put on clean gloves
- Check “GO BAG” (emergency travel bag) for disposable inner cannula
- If disposable inner cannula is available remove the inner cannula as per manufacturer’s instructions
- Open the package with the new disposable inner cannula, taking care not to contaminate the cannula or the inside of the package
- With your nondominant hand, stabilize the outer cannula and faceplate of the tracheostomy
- Grasp the locking mechanism of the inner cannula with your dominant hand remove the inner cannula as indicated per manufacturer’s instructions
- If you have difficulty removing the inner cannula, do not force it
- Stop and contact the student’s health care provider and parent/guardian
- Place the used inner cannula in a disposable bag
- Pick up new inner cannula with your dominant hand
- Stabilize the faceplate with your nondominant hand and gently insert the new inner cannula into the outer cannula
- Lock the inner cannula in place per manufacturer’s instructions
- Pull gently to ensure it is firmly in place (may be a “click” when in place)
- *See below”: Final Steps for Both Procedures
- If the student does not have a disposable inner cannula in “GO BAG” (emergency travel bag), follow the steps below for cleaning and re-inserting inner cannula
If the student does not have a disposable inner cannula in emergency travel bag, follow the steps below for cleaning and re-inserting inner cannula
Procedure for Cleaning and Re-inserting Inner Cannula:
- Assemble supplies and place on a clean surface
- Review student’s individual health plan/health care provider’s order
- Position student providing as much privacy as possible
- Explain the procedure at a level the student will understand
- Wash hands
- Have the person assisting wash hands and put on clean gloves
- Assess student’s respiratory status to ensure it is appropriate to change tracheostomy cannula at this time
- Put on clean gloves
- Check “GO BAG” (emergency travel bag) for disposable inner cannula
- Pour prescribed cleaning solution into in a clean basin
- Review health care provider’s orders for instructions on what cleaning solution to use (i.e. mild, fragrance free dish soap and water or equal parts hydrogen peroxide and water)
- With your nondominant hand, stabilize the outer cannula and faceplate of the tracheostomy
- Grasp the locking mechanism of the inner cannula with your dominant hand remove the inner cannula as indicated per manufacturer’s instructions
- Soak the inner cannula in a basin of the prescribed cleaning solution for the prescribed amount of time
- Using sterile pipe cleaners, remove any dried secretions from inside the cannula
- Do not scrub too hard as this may damage the tube
- Thoroughly rinse the cannula with sterile water
- Air dry the inner cannula with a gentle shake
- Stabilize the faceplate with your nondominant hand and gently insert the clean inner cannula into the outer cannula
- Lock the cannula in place per manufacturer’s instructions
- Pull gently to ensure it is firmly in place (may be a “click” when in place)
- *See below: Final Steps for Both Procedures
Final Steps for Both Procedures:
- Assess student’s respiratory status
- Remove gloves
- Document assessment, intervention, and outcomes in student’s healthcare record
- Follow up with parents/guardian and healthcare provider, as needed
References:
Children’s Mercy Kansas City. (2018). Office of evidence based practice (EBP) – Critically appraised topic: Tracheostomy emergency supplies. Retrieved June 8, 2023 from https://www.childrensmercy.org/contentassets/878a471901cd4e858cc27ae0d82f441e/trach-go-bag-cat.pdf
Children’s Mercy Kansas City. (n.d.). Tracheostomy tube. Retrieved June 7, 2023, from https://www.childrensmercy.org/siteassets/media/departments-and-clinics/otolaryngology/tracheostomy-care-parent-card.pdf
Lawrence, P. R., Chambers, R., Faulkner, M. S., & Spratling, R. (2021). Evidence-based care of children with tracheostomies: Hospitalization to home care. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses, 46(2), 83–86. https://doi.org/10.1097/RNJ.0000000000000254
Lynn, P. (2019). Providing care of a tracheostomy tube. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 331-333).
Medtronic. (2018). Cleaning your reusable inner cannula. Retrieved August 7, 2023, from https://www.livingwithatrach.com/living-with-a-tracheostomy/cleaning-your-reusable-inner-cannula.html
Nationwide Children’s. (2011, August, Reviewed 2019, June). Tracheostomy tube care with a reusable inner cannula. Retrieved June 21, 2023, from https://www.nationwidechildrens.org/-/media/nch/family-resources/helping-hands/documents/hhii191.pdf
Pediatric Home Service. (2015). Cleaning a reusable inner cannula. Retrieved August 7, 2023, from https://www.pediatrichomeservice.com/wp-content/uploads/2020/02/Shiley-Trach-Tube-with-Inner-Cannula_Cleaning.pdf
Porter, S.M., Page, D., Engholm. H., & Somppi, C. (2019). Students supported by medical technology. In Selekman, J. (Ed.), School nursing, a comprehensive text (3rd ed.). (pp. 721-740). Philadelphia PA.: F.A. Davis Co.
The StayWell Company, LLC. (2022, August 1). Cleaning your tracheostomy inner cannula and skin. Retrieved June 21, 2023, from https://uchealth.staywellsolutionsonline.com/Library/TestsProcedures/3,82486
UC Davis Children’s Hospital, Olarewaju, A. (2019). Ear, nose, and throat (ENT) pediatric tracheostomy handbook. Retrieved June 7, 2023, from https://health.ucdavis.edu/media-resources/children/documents/patient-education-A-to-Z/peds-tracheostomy-handbook.pdf
Page last updated: February 28, 2025
Page last reviewed: February 28, 2025
The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.