• 
  

  • Routine replacement (usually once a week).

  
  

  • Emergent replacement (occlusion with secretions, mucous plug, foreign body, or accidental dislodgment).

Absolute

• 
  

  • Insufficient training in procedure. (Children with tracheostomies should never be left in the care of someone who is not trained in replacement of a tracheostomy.)

• 
  

  • Suction catheters.

  
  

  • Sterile gloves.

  
  

  • Suction machine.

  
  

  • Saline bullets.

  
  

  • 5-mL syringe to deflate balloon, if applicable.

  
  

  • Tracheostomy ties.

  
  

  • Scissors.

  
  

  • New tracheostomy tube of appropriate size (1 of same size and 1 size smaller).

  
  

  • Lubrication (water soluble).

  
  

  • Oxygen with tubing.

  
  

  • Resuscitation bag.

• 
  

  • Inability to establish a new airway.

  
  

  • Perforation of airway.

  
  

  • Bleeding.

  
  

  • Infection.

• 
  

  • If replacement is emergent and no new tracheostomy tubes of appropriate size are available, an endotracheal tube of the same size can be used as a temporary airway.

  
  

  • Once the endotracheal tube is inserted, the old tracheostomy tube can be cleaned and replaced.

  
  

  • Size of tracheostomy tube is embossed on wings of tracheostomy tube.

  
  

  • Suctioning of the tracheostomy is only to clear the tube itself.

  
  

  • The suction catheter should not extend beyond the end of the tracheostomy tube. (Aggressive deep suctioning can lead to granulation tissue in the airway.)

  
  

  • If unable to insert same size tracheostomy tube, use 1 size smaller.