HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 11-19
Pediatrics: Tracheostomy Tie Change __RN
PURPOSE:
To prevent infection and skin breakdown of
tracheostomy and surrounding area.
CONSIDERATIONS:
1. Child should be restrained as needed. Two adults
are preferred for doing procedure. If only one
person available, put new ties on before cutting old
ties.
2. Have all equipment assembled prior to beginning
procedure.
3. Place a blanket roll under the shoulders to provide
access to the tracheostomy.
4. Suction before changing ties.
5. Placement of the knot should be alternated at each
change. Do not place over the carotid artery or at
the nape of neck.
EQUIPMENT:
Twill tape (or alternate type of ties)
Scissors
- cut two pieces of twill tape, each 12" long
- cut the end of the tape at a diagonal to make
threading easier
- check to see that the end will not unravel
- make a slit in each twill tape 1/2" from one end
Blanket roll
Tracheostomy tube of the same size
Gloves
PROCEDURE:
1. Adhere to Universal Precautions.
2. Explain procedure to caregiver and patient, in age
appropriate manner.
3. Have assisting adult place fingers on each side of
the flanges to hold the tracheostomy tube as close
to the neck as possible.
4. Carefully cut and remove tracheostomy ties without
tugging on tracheostomy tube.
5. Thread the slitted end of the twill tape up through
the tab and pull through past the slit.
6. Bring the free end of the twill tape through past the
slit and pull securely.
7. Repeat for other side.
8. Tie the ends of the twill tape in a loop around the
neck to secure the tracheostomy tube.
9. Apply gentle tension until the ties are snug around
the neck.
10. Tie the ends into a bow-tie.
11. Check the ties for tightness. One finger should just
fit between the ties and neck. If possible, check the
tension with child lying down and sitting up with
neck bent toward the chest.
12. Adjust the tightness as necessary.
13. Pull ends of bow-tie through making a secure
double knot. Tie one more loop making it a triple
knot.
ALTERNATE TIE PROCEDURE:
Supplies needed are the same as above except the twill
tape is 36" long.
1. Adhere to Universal Precautions.
2. Place your fingers on each side of the tabs to hold
the tracheostomy tube as close to the neck as
possible.
3. Cut and remove the tracheostomy ties carefully
without tugging on tracheostomy tube.
4. Thread the twill tape through the hole in one tab of
the tube. Bring the free ends of the twill tape
together behind the neck.
5. Thread one free end through the hole in the
opposite tab of the tube.
6. Gently hold the end of the tie to correctly align
around the neck.
7. Tie the ends of the twill tape in a loop around the
neck to secure the tracheostomy tube.
8. Apply gentle tension until the ties are snug around
the neck.
9. Tie the ends into a bow-tie.
10. Check the ties for tightness. One finger should just
fit between the ties and neck. If possible, check the
tension with child lying down and sitting up with
his/her neck bent toward the chest.
11. Adjust the tightness as necessary.
12. Pull ends of bow-tie through making a secure
double knot. Tie one more loop making it a triple
knot.
AFTER CARE:
1. Document in patient's record:
a. Date and time of procedure.
b. Assessment of tracheostomy site.
c. Patient's response to procedure.
d. Instructions given to caregiver.
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