Changing and Cleaning Tracheostomy Inner Cannula

<< RESPIRATORY

Considerations:

  • 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
  • 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

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 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
  • sterile suction catheters
  • sterile saline vials
  • water-based lubricant
  • 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 health plan/Healthcare provider’s order
  • Stethoscope
  • Sterile water
  • Hydrogen peroxide
  • Sterile pipe cleaners
  • Basin for cleaning
  • Personal protective equipment
    • gloves
    • goggles
    • mask
Procedure Download
Skill Competency Download

Procedure for Changing Inner Cannula:

  1. Assembles supplies and place on a clean surface
  2. Review student’s individual health plan/health care provider’s order
  3. Position student providing as much privacy as possible
  4. Explain the procedure at a level the student will understand
  5. Wash hands
  6. Assess student’s respiratory status to ensure it is appropriate to change tracheostomy cannula at this time
  7. Put on clean gloves
  8. Check “GO BAG” (emergency travel bag) for disposable inner cannula
  9. If disposable inner cannula is available remove the inner cannula as per manufacturer’s instructions
  10. Grasp inner cannula (may need to squeeze sides of inner cannula to loosen) and pull straight out
  11. Replace with new inner cannula and pull gently to ensure it is firmly in place (may be a “click” when in place)
  12. *See below: Final Steps for Both Procedures

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:

  1. Have person assisting with procedure wash hands and put on clean gloves
  2. Mix equal parts of sterile water and hydrogen peroxide in a clean basin
  3. Remove the inner cannula as indicated per manufacturer’s instructions
  4. Soak the inner cannula in a basin of half-strength hydrogen peroxide solution
  5. Using sterile pipe cleaners, remove any dried secretions from inside the cannula
  6. Thoroughly rinse the cannula with sterile water
  7. Replace with new inner cannula and pull gently to ensure it is firmly in place (may be a “click” when in place)
  8. Lock the cannula in place per manufacturer’s instructions
  9. *See below: Final Steps for Both Procedures

Final Steps for Both Procedures:

  1. Assess student’s respiratory status
  2. Remove gloves
  3. Document assessment, intervention, and outcomes in student’s healthcare record
  4. Follow up with parents/guardian and healthcare provider, as needed

References:

American Thoracic Society. (2000). Care of the child with a chronic tracheostomy. American Journal of Respiratory & Critical Care Medicine, 1, 297-308.

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

Acknowledgment of Update Reviewers:

Cynthia C. Griffith, RN, BSN
Nurse Clinician
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin

Cecilia Lang, MSN, CCRN, PNP-BC
Tracheostomy/Home Ventilator APN
Children’s Hospital of Wisconsin

Acknowledgment of Initial Reviewers:

Marcia Creasy, BSN, RN
Retired School Nurse

Cynthia C. Griffith, RN, BSN
Nurse Clinician
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin

Mary Kay Kempken, RN, BSN, NCSN
School Nurse
Randall Consolidated School

Cecilia Lang, MSN, CCRN, PNP-BC
Tracheostomy/Home Ventilator APN
Children’s Hospital of Wisconsin

Carole Wegner, MSN, RN
Clinical Nurse Specialist
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin

Page last updated: September 15, 2021
Page last reviewed: September 15, 2021

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.