Scheduled Changes of Tracheostomy Tubes
Currently, no empirical evidence indicates a standardized
time for changing a tracheostomy tube, and
changes are typically done according to the preference
of the health care provider. White et al17 suggest that
indications for changing a tracheostomy tube include
the need for a different size tube, tube malfunction,
need for a different type of tube, and routine changes
for ongoing airway management and prevention of
infection. They suggest that a tracheostomy tube should
be changed every 7 to 14 days after initial insertion, but
they acknowledge that no evidence supports that recommendation.
Mitchell et al2 recommend replacing the
initial tracheostomy tube within 10 to 14 days after
placement if a percutaneous procedure was used to
establish the tracheostomy and within 3 to 7 days if a surgical procedure was used. A tracheostomy tube inserted
percutaneously fits more tightly within the stoma than
does a tube that was inserted through a surgical incision.
If a tracheostomy tube is changed prematurely, the tissue
of the dilated stoma tract is more likely to recoil than
it would if the change were done later.18 In addition,
Mitchell et al2 recommend that patients should not be
discharged from the hospital with the tracheostomy tube
sutured in place because the first tracheostomy tube
change should be done before discharge.