- 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 Emergency Travel Bag accessible when completing any tracheostomy procedure
Considerations:
- 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
Supplies:
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
- Gather supplies
- Review Individualized Health Plan and healthcare provider’s orders
- Position the student
- If a shoulder roll is used, place it behind student’s shoulders
- Explain procedure at a level the student will understand
- Have person assisting with procedure wash hands and put on gloves
- Wash hands
- Put on gloves
- 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
- Use caution not to occlude the tracheostomy tube
- Insert one end of the tie through the slit opening on the side of the tracheostomy tube
- Bring the other end of the tie around the back of the neck
- Repeat with the other end of the tie through the slit opening on the other side of the tracheostomy tube
- 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
- The ties should allow enough space for one pinky finger between ties and neck
- If a dressing is used around the stoma, replace it now with a clean one
- Assess the student’s respiratory status to ensure that the tracheostomy tube remained in place and patent during the procedure
- Remove gloves
- Wash hands
- Documents assessment, procedure, and outcomes in the student’s healthcare record
- Follow up with parents/guardian and healthcare provider, as needed
References:
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: http://www.cincinnatichildrens.org/WorkArea/DownloadAsset.aspx?id=78219
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
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 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 10, 2015
Page last reviewed: November 10, 2015