There is no evidence to guide the frequency of tracheostomy tube changes. It is a common practice to change the tracheostomy tube when it is grossly soiled, if it malfunctions (e.g., cuff rupture), or if a tube of another design is needed (e.g., fenestrated tube). Changing the tracheostomy tube is not a benign procedure. Complications include inability to insert the replacement tube, insertion of the replacement tube into a false passage[74] (soft tissue of the neck or mediastinum), bleeding, and patient discomfort. The risk for these complications decreases with the age of the tracheal stoma. For this reason, it is recommended that changing the tracheostomy tube be avoided for at least 1 week after surgical creation of the stoma and that the first tube change is performed by the surgeon who performed the tracheotomy. If a difficult tracheostomy tube change is anticipated (e.g., obese patient, airway anomaly, short and thick neck), a clinician experienced in endotracheal intubation should be present.