The first time a tracheostomy tube is changed, this should be done by someone competent to manage the stoma and upper airways should the tube change prove difficult. Ensure that you have the right equipment and personnel immediately available if you need them. Position the patient comfortably (for you and the patient) with the head extended (looking towards the roof). A pillow or roll under the shoulder blades can help.

The first tube change is often done by inserting a bougie or similar device into the trachea via the existing tube. You can use a suction catheter in a child. In the elective situation, the old tube is positioned correctly within the airway and so the concerns about creating a false passage (which may occur when introducing a bougie into a displaced tracheostomy) are much reduced. Experienced staff may choose not to use a bougie as an exchange device.

The difficulty and technique of the tube change should be recorded for subsequent procedures. A tracheostomy passport is useful here.

Assuming the tube change was uneventful, subsequent tube changes can be more relaxed.

Fig 1 is a video demonstrating an elective tube change in a patient with an established stoma. Note the key steps as you watch.