Tracheostomy tubes with an inner cannula are inherently safer than ones without an inner cannula and are therefore advocated (NTSP [206]). Regular checking and changing of the inner cannula allows for visual inspection of secretions and assists in assessment regarding humidification, reducing the risk of airway obstruction.

The inner cannula should be removed (Figure 12.52), inspected and changed if required. Although this should be done at regular intervals, the frequency of inspection will depend on the volume and tenacity of the patient's secretions. Patients with copious secretions may require 2‐hourly inner tube changes, while a patient with a good cough and minimal secretions will require much less frequent checks. The timing should be determined following assessment of the patient and their secretions, and documented in the tracheostomy passport. Inner cannulas should either be cleaned or disposed of after each use according to the manufacturer's recommendations.

The altered airway will remain patent and free from secretions, which have the potential to obstruct the tracheostomy tube. The inner cannula change will be done confidently and efficiently, causing the patient minimal distress and anxiety.