Changing Tracheostomy Inner Cannula



  • Attempt to provide the student with as much privacy as possible, given the urgency of the situation
  • Should always have 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


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

  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 emergency travel bag for disposable inner cannula
  9. If disposable inner cannula is available remove the inner cannula as per manufacturer’s instructions
  10. Reinsert the inner cannula by turning it 90 degrees from its usual position, introduce the tip into the outer cannula, slowly rotating it back 90 degrees to its final position
  11. 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
  12. Have person assisting with procedure wash hands and put on clean gloves
  13. Mix equal parts of sterile water and hydrogen peroxide in a clean basin
  14. Remove the inner cannula as indicated per manufacturer’s instructions
  15. Soak the inner cannula in a the basin of half-strength hydrogen peroxide solution
  16. Using sterile pipe cleaners, remove any dried secretions from inside the cannula
  17. Thoroughly rinse the cannula with sterile water
  18. Reinsert the inner cannula by turning it 90 degrees from its usual position, introduce the tip into the outer cannula, slowly rotating it back 90 degrees to its final position
  19. Lock the cannula in place per manufacturer’s instructions
  20. Assess student’s respiratory status
  21. Remove gloves
  22. Document assessment, intervention and outcomes in student’s healthcare record
  23. Follow up with parents/guardian and healthcare provider, as needed


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:

Acknowledgment of 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: November 11, 2015
Page last reviewed: November 11, 2015