When and how to change your tracheostomy tube

A tracheostomy tube replacement is a procedure you perform on yourself or a caregiver performs on you at home, usually every 4 to 8 weeks depending on the tube type and your doctor's instructions. The tube sits in an opening in your windpipe and needs to be swapped out before it becomes blocked, damaged, or colonized by bacteria. Most people with a stable tracheostomy can learn to do this safely with proper training and the right supplies on hand.

Your doctor or a respiratory therapist will teach you the exact steps during your hospital stay or at an outpatient clinic visit. This guide explains what the process involves so you understand what to expect and what can go wrong. If you have not yet received hands-on training, do not attempt a tube change without supervision — the first replacement should always happen with a healthcare provider present.

Key Takeaways

  • Tracheostomy tubes typically need replacement every 4 to 8 weeks, and your doctor will tell you the schedule for your specific tube type.
  • You must receive hands-on training from a respiratory therapist or ENT nurse before performing a tube change at home.
  • Keep an emergency kit at your bedside with a new tube, obturator, tie, lubricant, and suction equipment in case the tube becomes blocked or dislodged.
  • The stoma (the opening in your windpipe) can close within hours if the tube is removed and not replaced quickly, so speed and preparation are critical.
  • Call 911 or go to the emergency room if you cannot reinsert the tube, if you have severe difficulty breathing, or if the tube is visibly damaged.

Gather your supplies before you start

Lay out all equipment on a clean surface before you remove the old tube. You will need the new tracheostomy tube (the same size and type as the one you are replacing), the obturator (the solid rod that slides inside the new tube to make insertion easier), clean tracheostomy ties or a fastener, water-soluble lubricant, gauze pads, a suction catheter and suction machine, a mirror, and a light source. Some people also keep a backup tube of the same size within arm's reach in case the first insertion fails.

Check the expiration date on the new tube and make sure the obturator slides smoothly in and out. If you use a cuffed tube (one with an inflatable balloon), have the cuff inflation syringe ready. Wash your hands thoroughly with soap and water, or use hand sanitizer if soap is not available. If you wear gloves, put them on now — some people prefer bare hands for better tactile feedback, which is fine as long as your hands are clean.

Remove the old tube safely

Suction your airway first to clear any secretions, then deflate the cuff if your tube has one by withdrawing all air from the inflation syringe. Untie or unfasten the tracheostomy ties that hold the tube in place. Take a breath and hold it, then gently remove the old tube by pulling it straight out at a slight downward angle — do not twist or force it. The stoma will stay open for a short time, but it begins to close within minutes, so work quickly.

If the old tube is blocked or damaged, you may see thick secretions, blood, or visible cracks. Place the old tube aside on a clean surface — you may need to show it to your doctor if something went wrong. Do not panic if you cough or feel short of breath for a moment; this is normal. Take a few breaths through your mouth and nose while you prepare the new tube.

Insert the new tube with the obturator in place

Coat the new tube and obturator with water-soluble lubricant — a thin, even layer on the outside of the obturator and the first inch or two of the tube. Do not use petroleum jelly or oil-based lubricants, as these can damage the tube material and are harder to clean out of your airway. Hold the tube and obturator together as one unit, with the obturator fully inserted inside the tube.

Position yourself in front of a mirror if possible. Gently insert the tube and obturator together into the stoma at a slight downward angle, using the same path the old tube took. You should feel mild resistance but not pain or a grinding sensation. Slide the tube in until the flange (the flat part that sits against your neck) is flush against your skin. Once the tube is fully inserted, when ready remove the obturator by pulling it straight out — the tube stays in place.

Take a breath through the tube to confirm it is patent (open and clear). If you cannot breathe through it or feel resistance, stop and call your doctor or go to the emergency room. Do not force the tube deeper or try to reinsert the obturator.

find the tube and inflate the cuff if needed

Thread clean tracheostomy ties through the holes on both sides of the flange and tie them snugly behind your neck — tight enough that you cannot slip a finger underneath, but not so tight that it cuts off circulation or causes pain. Some people use a Velcro fastener instead of ties, which is faster and easier to adjust. Make sure the tube does not move side to side or up and down when you gently tug on it.

If your tube has a cuff, inflate it using the cuff inflation syringe. Your doctor will tell you the correct pressure (usually 20 to 30 centimeters of water) or the volume to inject. Do not over-inflate — this can damage the tracheal wall. Some tubes have a pressure-relief valve that prevents over-inflation automatically. Once the cuff is inflated, cap the inflation line so air does not leak out.

Clean up and monitor for problems

Suction through the new tube to clear any lubricant or secretions. Place a clean tracheostomy pad (a small gauze pad with a slit) under the flange to absorb drainage and keep the skin dry. Change this pad daily or whenever it becomes wet or soiled. Wash the old tube with soap and warm water, dry it completely, and store it in a clean, dry place as a backup in case your current tube becomes damaged.

Watch for signs that something is wrong over the next few hours: difficulty breathing, wheezing, a high-pitched sound when you inhale, blood in your secretions, or pain around the stoma. Minor bleeding or a small amount of blood-tinged secretions can happen after a tube change, but heavy bleeding or persistent difficulty breathing means you should call your doctor or go to the emergency room. Keep your suction equipment nearby and your phone within reach for the first 24 hours after a new tube insertion.

When to call a doctor or go to the emergency room

Seek when ready medical attention if you cannot insert the new tube after two attempts, if the tube is visibly cracked or damaged after insertion, if you have severe difficulty breathing or a feeling of panic, if you cough up large amounts of blood, or if the stoma shows signs of infection (redness, warmth, pus, or foul odor that does not improve with cleaning). You should also call your doctor if the tube feels uncomfortable or loose after 24 hours, if you develop a fever, or if your secretions change color or smell.

If the tube comes out accidentally and you cannot reinsert it within a few minutes, go to the emergency room when ready. The stoma can close quickly, and you may need help from a respiratory therapist or doctor to reopen it. Keep your doctor's phone number and your hospital's main line posted near your bed so you can reach someone quickly if you need help.

Frequently Asked Questions

What if I cannot get the obturator out after inserting the tube?

Stop and do not force it. Call your doctor or go to the emergency room. The obturator may be stuck because the tube is kinked or inserted at the wrong angle. A healthcare provider can safely remove it and reposition the tube if needed. Do not try to remove it by pulling hard, as this can damage the tube or your airway.

How long can I leave the tube out while changing it?

The stoma can begin to close within 5 to 10 minutes, especially if it is a newer tracheostomy (less than a few weeks old). Work as quickly as possible, but do not rush so much that you insert the tube incorrectly. If you are not confident you can complete the change in under 10 minutes, ask a caregiver to be present and ready to call for help.

Is it normal to see blood when I change the tube?

A small amount of blood or blood-tinged secretions can happen, especially if the stoma is irritated or if you bump the tissue during insertion. Gentle suction and a clean pad usually stop minor bleeding within a few minutes. Heavy bleeding, bleeding that does not stop after 15 minutes, or blood clots are not normal and warrant a call to your doctor.

Can I change my tube less often than my doctor recommends?

No. Tubes accumulate bacteria, dried secretions, and mineral deposits over time, and they can become brittle or develop small cracks. Changing on schedule reduces the risk of infection and tube failure. If you are having problems with your tube lasting the recommended time, talk to your doctor about whether a different tube type might work better for you.

What should I do if the new tube feels too loose?

Tighten the ties or fastener so the tube does not move when you gently tug on it. If it still feels loose after tightening, or if it feels uncomfortable, call your doctor. The tube may be the wrong size, or the stoma may have changed shape. Do not leave a loose tube in place, as it can fall out or move into the wrong position.