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Tracheostomy: dressing and tube tape or tie change

Evidence‐based approaches

Rationale

Tracheostomy dressing and tube tie or tape change is carried out to keep the surrounding skin clean and dry and free from infection and pressure damage. It also helps to keeps the tracheostomy tube secure, preventing accidental decannulation.

Indications

The tracheostomy stoma directly exposes the trachea to the environment and so is a potential route for infection. Secretions can cause irritation and maceration of the surrounding skin, and the tracheostomy tube itself may cause pressure damage to the patient's neck area. To prevent tissue damage and wound breakdown, the site should be inspected regularly and cleaned and dried as required (Everitt [75]). A specific foam tracheostomy dressing may be used to help absorb secretions, prevent pressure sores and increase patient comfort. The dressing should be changed at least every 24 hours or more frequently if required (Dawson [58]).
All tracheostomy tubes must be secured with the use of tube tapes or ties (ICS [116], Mitchell et al. [161]). These are attached to either side of the flange and connected at the side or back of the patient's neck. They should be changed if they become soiled or wet.

Contraindications

Occasionally the ENT surgical team may request that the original dressing be left and not changed for a specific period of time. This is usually due to the increased risk of bleeding associated with new stoma formation.
They may also request that tube tapes or dressings are not used if a surgical flap has been made and there is concern that any pressure from the dressing or tapes may restrict blood flow and cause the flap to fail (Mitchell et al. [161]). In this scenario, the tube must be sutured in place and great care taken that the tube is not accidentally dislodged.

Principles of care

Changing a tracheostomy dressing requires two people: one to hold and secure the tracheostomy tube while the other removes, cleans and then reapplies the tube tapes and new dressing (Dawson [58]). The stoma site should be cleaned thoroughly with 0.9% sodium chloride and allowed to air dry before an appropriate tracheostomy dressing is applied. This should be a foam dressing with a cross‐shaped incision to fit around the tracheostomy tube (ICS [116]). For patients with secretions that tend to accumulate around the stoma, a specialized barrier product can be used to protect the skin and prevent tissue breakdown (Dawson [58]). Once the dressing is in place, the tube tapes should be reapplied (or renewed if soiled or wet). The tapes should be tight enough that they keep the tube secure, but not so tight that they are uncomfortable for the patient. As a guide, two fingers should fit comfortably between the patient's neck and the tapes (Dawson [58], NTSP [206]).

Anticipated patient outcomes

The skin around the stoma and neck area will remain clean and dry, and free from infection and tissue damage. Additionally, the tube will remain firmly in place, reducing the risk of accidental decannulation.
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