- 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 health care team.
- Ensure the comfort of your child during the care by using different positioning and distraction techniques.
- 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.
Method for securing the tracheal cannula
|Types of tracheostomy ties||Advantages||Disadvantages|
|Velcro® band (cushioned band that attaches with velcro)||
- 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.
- Handwashing is required before and after this procedure.
- 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.
- Mild, non-perfumed, non-oily soap (eg, “Dove”)
- Clean, dry towel
- Rolled towel to be placed under the child’s shoulders, if needed
- For Velcro® band:
- Tweezers to help in threading the ends into the flange opening (if needed)
- For cotton ribbons:
- 1 or 2 ribbons, depending on the technique used
- Pointy object (eg, tip of a pencil) that can be used to pierce fastening holes, if using double ribbon technique. Do not use scissors because they may cause the ribbon to fray and fine threads may be aspirated into the tracheal cannula
- Tweezers to help in threading of the ties into the opening of the flange, if needed
- Round-ended scissors to cut the soiled tracheostomy ties
- Tape, if using double ribbon technique: aids in securing the first knot near the flanges. It is helpful to have extra pre-cut ties of the appropriate length to serve as a guide for ties to be used in the future.
If needed: suction device and suction catheters
Always have necessary equipment in case of emergency near at hand.
Refer to your child’s health care 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 health care team for adjustments to step 14 and onwards.