Changing Tracheostomy Ties

<< RESPIRATORY

  • *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. 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

Considerations:

  • If student’s “GO BAG” contains a battery charged suction machine, the school should check the battery charge level daily to ensure it is fully charged
  • The school nurse should establish a schedule to periodically check the “GO BAG” to ensure all the necessary supplies are available, not expired, and are in working condition
  • A shoulder roll is recommended to assist with the visualization and access to thetracheostomy 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:

“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 one)
  • unscented and dye free soap
  • syringe, if needed for tracheostomy 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 Individualized Healthcare Plan (IHP)
  • Healthcare provider’s order
  • Parent/guardian authorization form
  • Personal protective equipment
    • goggles
    • mask
    • gloves
  • Tracheostomy ties
  • Blunt scissors
  • Gauze
  • Blanket role to place under student’s shoulders, if needed
  • Stethoscope
Procedure Download
Skill Competency Download

Procedure:

  1. Gather supplies
  2. Place on a clean surface
  3. Review Individualized Health Plan and healthcare provider’s orders
  4. Ensure proper documentation of parent/guardian to perform the procedure
  5. Position the student
    • If a shoulder roll is used, place it behind student’s shoulders
  6. Explain procedure at a level the student will understand
  7. Have person assisting with procedure wash hands and put on gloves
  8. Wash hands
  9. Put on gloves
  10. If tracheostomy tube dressing is present, remove
  11. One caregiver should hold the tracheostomy in place while the second caregiver (registered nurses) removes the tracheostomy ties
  12. 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
  13. Use caution not to occlude the tracheostomy tube
  14. Insert one end of the tie through the slit opening on the side of the tracheostomy tube
  15. Bring the other end of the tie around the back of the neck
  16. Repeat with the other end of the tie through the slit opening on the other side of the tracheostomy tube
  17. 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
  18. The ties should allow enough space for one pinky finger between ties and neck
  19. If a dressing is used around the stoma, replace it now with a clean one
  20. Assess the student’s respiratory status to ensure that the tracheostomy tube remained in place and patent during the procedure
  21. Remove gloves
  22. Wash hands
  23. Documents assessment, procedure, and outcomes in the student’s healthcare record
  24. Follow up with parents/guardian and healthcare provider, as needed

References:

Children’s Hospital St. Louis. (n.d.) Tracheostomy home care. Retrieved June 7, 2023, from https://media.bjc.org/sitelinks/tracheostomy/a001_introduction_welcome.html

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

Children’s Mercy Kansas City. (n.d.). Tracheostomy care-changing the ties and stoma and neck care. Retrieved June 7, 2023, from https://www.childrensmercy.org/siteassets/media/departments-and-clinics/otolaryngology/tracheostomy-care—changing-the-ties-and-skin-care-parent-card2.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).

Pediatric Home Services. (2017). Trach stoma care (Cuidado del estoma). Retrieved June 7, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/trach-stoma-care/?play=1

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.