Changing Tracheostomy Ties


  • Changing tracheostomy ties in the school setting is usually not done on a routine basis, rather it would be completed on an emergency situation such as an emergency tracheostomy change
  • When caring for a student who has a tracheostomy, the nurse should always know the reason for the tracheostomy, the child’s underlying health conditions and whether the child needs the tracheostomy to breathe
  • Two people should be present during the procedure in the event of accidental decannulization
  • Should always have “GO BAG” (Emergency Travel Bag) accessible when completing any tracheostomy procedure


  • A shoulder roll is recommended to assist with the visualization and access to the tracheostomy site
  • The two most common forms of tracheostomy ties are a soft padded tie with Velcro tabs (most common) or a simple thin cloth or twill tie that requires tying to secure
  • Attempt to provide the student with as much privacy as possible, given the urgency of the situation


“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
  • 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:

  • Personal protective equipment
    • goggles
    • mask
    • gloves
  • Tracheostomy ties
  • Blunt scissors
  • Gauze
  • Stethoscope


  1. Gather supplies
  2. Review Individualized Health Plan and healthcare provider’s orders
  3. Position the student
    • If a shoulder roll is used, place it behind student’s shoulders
  4. Explain procedure at a level the student will understand
  5. Have person assisting with procedure wash hands and put on gloves
  6. Wash hands
  7. Put on gloves
  8. Remove the old ties while holding the tracheostomy tube in place
    • Removal of cloth ties requires the use of a blunt scissor
    • Removal of Velcro tab ties is done by detaching each end of the tie
  9. Use caution not to occlude the tracheostomy tube
  10. Insert one end of the tie through the slit opening on the side of the tracheostomy tube
  11. Bring the other end of the tie around the back of the neck
  12. Repeat with the other end of the tie through the slit opening on the other side of the tracheostomy tube
  13. Fasten the tracheostomy ties
    • Velcro tabs are fastened back on themselves
    • Cloth ties are secured using a single square knot on the side or back of the neck
  14. The ties should allow enough space for one pinky finger between ties and neck
  15. If a dressing is used around the stoma, replace it now with a clean one
  16. Assess the student’s respiratory status to ensure that the tracheostomy tube remained in place and patent during the procedure
  17. Remove gloves
  18. Wash hands
  19. Documents assessment, procedure, and outcomes in the student’s healthcare record
  20. Follow up with parents/guardian and healthcare provider, as needed


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

Children’s Hospital of Wisconsin. Caring for Kids with Tracheostomies: Changing the Trach Ties.

Cincinnati Children’s Hospital Medical Center. (2011). Best evidence statement (BESt). Basic pediatric tracheostomy care. Available at:

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:

Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J. (1997). Children and Youth Assisted by Medical Technology in Educational Settings. Guidelines for Care. Second Edition. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624

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.