• Tracheostomy ties help stabilize and keep the tracheal cannula securely in place. They are inserted in the openings found on each flange on the tracheal cannula.
  • Below is a suggested method that can serve as a guide; discuss the care and equipment required specifically by your child with your child’s healthcare team.

Method for securing the tracheal cannula

Types of tracheostomy ties Advantages Disadvantages
Cotton ribbons
  • Very economical
  • Not reusable
  • More frequently irritates the skin: the knots made to tie the two ribbons may cause friction against the neck
  • May cause possible skin breakdown in children that are overweight or who have a small neck
Velcro® band (cushioned band that attaches with velcro)
  • Comfortable
  • Less irritating to the skin
  • Easy to use
  • Easily adjustable
  • Can be reused after washing as long as the velcro fastens securely
  • Can be detached by young children
  • More expensive


  • A Velcro® band is usually the first choice, but cotton ribbons can also be used.
  • The Velcro® band is composed of a piece of material that rests on the child’s neck; this piece of fabric has 2 thin bands at each end that can be inserted into the openings of each flange.
  • The most important thing to consider when of choosing tracheostomy ties is not the material that they are made of, but the safety of maintaining the cannula in the tracheostomy.
  • In order to prevent irritation of the skin, the tracheostomy ties must remain clean at all times.
  • Changing the tracheostomy ties is simple but to prevent accidental decannulation, it is recommended that it be done with 2 people. The first person stabilizes the tracheal cannula by placing their fingers on the flanges, while the second person changes the tracheal ties.
  • Good handwashing is essential before and after providing care.
  • Ensure the comfort of your child during the care by using different positioning and distraction techniques.


  • To prevent skin irritation, the tracheostomy ties must be changed 2 times per week or more often if needed.
  • The tracheostomy ties must also be changed:
    • if wet,
    • if soiled,
    • if no longer in good condition,
    • if there is a bad odour,
    • if too tight or too loose (cotton ribbons),
    • if the velcro no longer holds (sticks) properly,
    • when changing the tracheal cannula.
  • The best time to change the tracheostomy ties is during bath time; allows you to examine and wash the neck.
  • The tension and condition of the tracheostomy ties along with the appearance of the skin under the ties must be verified at least once a day; look for redness, irritation or presence of pressure points.

Required materials:

Refer to your child’s healthcare team if the care, material or the sequence of steps taught are different than those described.

Some parents may prefer examining, cleaning and drying the skin on the neck after having removed the soiled tracheostomy ties. If this is the case, refer to your child’s healthcare team for adjustments to step 14 and onwards.

Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
Step 8
Step 9
Step 10
Step 11
Step 12
Step 13
Step 14
Step 15
Step 16
Step 17
Step 18
Step 19
Step 20
Step 21
Step 22