1. Objective

To provide a safe and standardized procedure for changing a tracheostomy tube, ensuring patient comfort, minimizing infection risk, and promoting airway management continuity.

2. Scope

This SOP applies to all licensed healthcare professionals providing tracheostomy tube change services under Upashay’s doctor services. It is intended for scheduled tube changes, not emergency replacements.

3. Required Personnel

  • Licensed doctor or registered nurse with training in tracheostomy care
  • Trained assistant (optional, for additional support)

4. Required Equipment and Supplies

  • Sterile tracheostomy tube of appropriate size
  • Sterile gloves
  • Personal protective equipment (PPE): mask, face shield, gown
  • Sterile saline solution or water for lubrication
  • Tracheostomy ties or securement device
  • Sterile suction catheter and suction machine
  • Sterile gauze and dressing supplies
  • Resuscitation equipment (ambu bag and oxygen, as needed)
  • Stethoscope
  • Pulse oximeter (optional, for monitoring oxygen saturation)

5. Pre-Procedure Preparation

  1. Patient Assessment
    • Review the patient’s medical history, current tracheostomy tube status, and any recent complications or issues.
    • Assess the patient’s respiratory status, including oxygen saturation, respiratory rate, and tracheostomy site condition.
    • Obtain informed consent, explaining the procedure, risks, and any expected discomfort to the patient.
  2. Environment Preparation
    • Ensure a clean and sterile environment to minimize infection risk.
    • Assemble all necessary equipment within easy reach before beginning the procedure.
    • Position the patient comfortably, usually in a semi-Fowler’s position, ensuring easy access to the tracheostomy site.
  3. Hand Hygiene and PPE
    • Perform hand hygiene thoroughly before donning sterile gloves.
    • Wear appropriate PPE to protect both the patient and healthcare provider.

6. Procedure Steps

  1. Airway Suctioning (if required)
    • Pre-oxygenate the patient if needed, then suction the tracheostomy tube to clear secretions.
    • Remove gloves and perform hand hygiene if suctioning is done.
  2. Removing the Old Tracheostomy Tube
    • Put on new sterile gloves.
    • Stabilize the tracheostomy tube with one hand, while using the other hand to carefully remove the ties or securement device.
    • Gently remove the old tracheostomy tube in a smooth, controlled motion, ensuring the airway remains unobstructed.
  3. Inserting the New Tracheostomy Tube
    • Lubricate the new tracheostomy tube with sterile saline solution or water.
    • Gently insert the new tube along the path of the stoma, ensuring smooth insertion.
    • Confirm placement by checking airflow, observing chest rise, and listening with a stethoscope.
  4. Securing the New Tube
    • Attach new tracheostomy ties or securement device snugly but comfortably, ensuring the tube remains stable.
    • Check that the ties allow for one finger’s width between the ties and the patient’s neck.
  5. Post-Insertion Monitoring
    • Monitor the patient’s respiratory rate, oxygen saturation, and comfort level.
    • Assess for any signs of respiratory distress, bleeding, or infection around the tracheostomy site.
  6. Dressing the Site
    • Apply sterile gauze around the tube to absorb secretions and keep the area clean.

7. Post-Procedure Care

  1. Education and Documentation
    • Educate the patient and any caregivers on proper tracheostomy tube care, signs of infection, and when to seek medical attention.
    • Document the procedure, including tube size, type, reason for change, patient response, and any complications.
  2. Dispose of Waste
    • Safely dispose of used equipment, PPE, and dressing materials following biohazard disposal guidelines.

8. Emergency Protocols

  • Be prepared to provide immediate assistance if complications arise, such as difficulty inserting the tube, respiratory distress, or accidental tube dislodgement.
  • Follow emergency protocols and use resuscitation equipment if necessary.

9. Quality Assurance and Safety Compliance

  • Ensure compliance with infection control protocols and safety standards.
  • Conduct periodic reviews of the procedure with healthcare staff to improve patient care and address any procedural concerns.