[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Procedures](https://durgical.com/en/nursing/areas/procedures/) › Tracheostomy care # Tracheostomy care - Procedure Clean the stoma and inner cannula, change the dressing and the ties with two people, and always keep emergency equipment at the bedside. Updated Nov 5, 2026 ## Key points - At the bedside: obturator, a spare tube of the same size and one size smaller, a cuff syringe, ties and a bag-valve-mask. - Change the ties with two people: one holds the tube while the other secures it. - Ties are left loose enough for one finger. - Assess the stoma and change the dressing at least once per shift, and at once if it is wet or soiled. - Inspect the inner cannula at least twice a day and clean or replace it per protocol. ## What it is A tracheostomy is a surgical stoma in the neck through which a tube enters the trachea directly. It has an outer cannula with a flange secured by ties, often a cuff and, in many, an inner cannula that is cleaned or replaced so it does not block. Routine care keeps the flange, inner cannula, dressing and skin clean, so fewer bacteria reach the lungs. The most serious risk is accidental decannulation, so reinsertion equipment must always be at hand. ## Indications - Every patient with a tracheostomy: routine care per protocol, at least once per shift. - A wet, soiled or secretion-covered dressing. - An inner cannula with secretions narrowing its lumen. - Ties that are soiled, wet or loose. ## Contraindications and precautions - Check that a spare tracheostomy tube and the emergency equipment are present before starting. - If the patient needs continuous oxygen, keep it near the outer cannula while the inner cannula is out. - Do not remove the old ties until the new ones are secured. - If on mechanical ventilation, keep the head of the bed at 30-45° to prevent pneumonia. - A patient with a non-fenestrated tube cannot speak: leave a way to communicate within reach. ## Equipment - A sterile tracheostomy kit, or applicators, gauze and a pre-cut tracheostomy dressing, all sterile. - Sterile saline and basins, a brush or pipe cleaners for the inner cannula. - New ties or holder, sterile gloves, a mask and eye protection. - Suction equipment, a pulse oximeter and a bag-valve-mask. ## Step by step (and why) - Identify, explain and place in semi-Fowler's; check the spare equipment — accidental decannulation needs fast reinsertion. - Suction secretions if indicated — so they do not soil the new dressing or block the tube. - Remove the soiled dressing and look at drainage, odour and the stoma — the stoma shows infection or pressure injury. - With sterile technique remove the inner cannula and clean or replace it by type — a clean inner cannula prevents blockage. - Rinse, dry and reinsert the inner cannula, locking it with a gentle tug — a poorly locked cannula can come out. - Clean the stoma with saline from the stoma outward, one gauze per stroke, and dry — moisture irritates and favours infection. - Apply a sterile pre-cut dressing touching only its edges — it absorbs secretions and protects the skin under the flange. - Change the ties with two people, leaving one finger of slack — it prevents decannulation and pressure on the neck. - Give mouth care and record stoma, secretions and tolerance — mouth care helps prevent pneumonia. ## Complications - Accidental decannulation or displacement: a life-threatening emergency. - Tube blockage from secretions or a mucus plug. - Stoma infection: redness, warmth, pain, purulent drainage or odour. - Pressure injury under the flange or from ties that are too tight. - Healthcare-associated pneumonia. ## Next step: when to call for help - If the tube comes out or the patient cannot breathe through it, call for urgent help and use the emergency equipment per protocol. - Report a stoma that is red, warm, painful or has purulent drainage. - Report secretions that change in colour, odour or amount. - Report falling saturation or increasing breathing difficulty. ## Test yourself Think of the answer, then tap the question to see it. ## What equipment must always be at the bedside of a patient with a tracheostomy? The obturator, a spare tube of the same size and one size smaller, a cuff syringe, ties, lubricant and a bag-valve-mask. ## How loose should tracheostomy ties be? Loose enough for one finger to slip under the tie: they hold the tube without compressing the neck. ## Why are the ties changed by two people? Because one holds the tube while the other changes the securement, which reduces the risk of the tube coming out. ## How often is the stoma assessed and the dressing changed? At least once per shift, and at once if the dressing is wet or soiled. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/tracheostomy-care/) ## Connections ## Related 2 - [Airway suctioning: oral, nasal and artificial airways](https://durgical.com/en/nursing/airway-suctioning-oral-nasal-and-artificial-airways/) - [Oxygen therapy: devices, flows and safety](https://durgical.com/en/nursing/oxygen-therapy-devices-flows-and-safety/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Skills, 12.6: Checklist for Tracheostomy Care and Sample Documentation](https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Skills_(OpenRN)/12%3A_Tracheostomy_Care_and_Suctioning/12.06%3A_Checklist_for_Tracheostomy_Care_and_Sample_Documentation) (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); [Nursing Skills, 12.2: Basic Concepts Related to Suctioning](https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Skills_(OpenRN)/12%3A_Tracheostomy_Care_and_Suctioning/12.02%3A_Basic_Concepts_Related_to_Suctioning) (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/tracheostomy-care/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/tracheostomy-care/