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CION Cancer Clinics
Changing a tracheostomy tube: how often, and what happens | CION Cancer Clinics
The whole tracheostomy tube is changed far less often than the inner tube is cleaned. The first change is always done in hospital, usually within the first week or two, once the track into the windpipe has healed. After that most tubes are changed about once a month, on an interval set by the tube maker and your team. This page explains why, what happens, and who should be doing it. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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The short answer
How often is a tracheostomy tube changed?
The whole tube is changed far less often than the inner tube is cleaned. The first change is always done in hospital, usually within the first week or two, once the track into the windpipe has healed. After that, most tubes are changed about once a month, and the exact interval is set by the tube maker and your team.
Why the first change waits
In the first days the opening in the neck is a fresh wound. If the tube came out then, the track could close within minutes and be hard to find again. By the time the first change is due, the track has firmed up into a channel, and a new tube slides in along it. The surgeon or the tracheostomy team does that first change, with everything ready in case it does not go smoothly.
Why later changes are simpler
Once the track is well formed, a routine change is a short procedure. Many families are taught to do it at home. Others come to the clinic for it. Which applies to you depends on the tube type, how settled the stoma is, and how confident the carer feels.
The interval is a maximum, not a target. A tube that is cracked, crusted inside, or has a leaking cuff is changed when that happens, whatever the calendar says.The reasons
Why is a tube changed at all?
Five reasons cover almost every change. Only the first is on a schedule.
Routine
Plastic slowly stiffens and the inside collects a film that cleaning cannot remove. Makers give a maximum life for each tube.
A crusted or blocked tube
If the main tube is blocked below where the inner tube reaches, or has no inner tube, the only way to clear it is to replace it. This is the one change that can be urgent.
A leaking cuff
A cuff that will not stay up cannot seal the airway. For someone on a ventilator or with an unsafe swallow, that means a change soon rather than at the next routine date.
A different size or type
As breathing improves, the team may move to a smaller tube, an uncuffed one, or one with a window for speaking. Each of those is a tube change, and the first of each kind is done in hospital.
Usually a step forward
- Cuffed to uncuffed
- A size down before capping
- Plain to fenestrated for a speaking valve
Damage
A cracked flange, a torn cuff line, a lock that no longer holds the inner tube. A damaged tube is replaced as soon as a spare is to hand.
Not sure whether this applies to you?
Ask an oncologistOn the day
What happens during a routine tube change?
Everything laid out first
The new tube of the same size, one a size smaller, lubricant, new tapes, suction, and a torch. Hands washed. The person sits up with the neck slightly extended, and is told each step before it happens.
The old tube comes out
The tapes are undone, the cuff let down if there is one, and the tube is drawn out in one smooth curve. Expect a cough and a little mucus. The stoma is wiped and looked at.
The new tube goes in
With its introducer inside, the new tube is guided along the curve of the track, without force. The introducer is pulled out at once, and air should move freely through the tube.
Checks
Breathing is watched. If the tube is cuffed, the cuff is refilled and its pressure checked with a gauge. The inner tube goes in, the tapes are tied so one finger fits underneath, and the skin under the flange is checked.
Afterwards
The old tube is cleaned or binned as the team advised. The date and size go in the diary. A slight soreness at the stoma for a day is common.
Side by side
A routine change and an emergency change, compared
Routine change
Emergency change
Planned by date, in the morning, with time to spare
Done at once because the tube is blocked or out
Done by the team, or by a trained carer at home
Done by whoever is there, with the emergency number on speaker
Same size tube, with the introducer
Same size first; the smaller spare if it will not pass
Always followed by a diary entry
Always followed by a call to the team, even if it went well
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
!
One thing that cannot wait
If a tube has come out or been taken out and the new one will not go in, do not keep pushing. Try the smaller spare once, gently. If that will not pass either, and the person is struggling to breathe, call the emergency number, cover the stoma with a clean cloth if you were taught to, and give breaths by the mouth as you were shown. Forcing a tube can push it into the tissue beside the windpipe, which is worse than no tube at all.
Commonly believed
Four things families tell us, and what is actually true
"The tube has not caused trouble, so it does not need changing."
The film inside a plastic tube and the stiffening of the material are not visible from outside. A tube past its life can crack at the flange or block at the tip without warning. Keep to the interval the team gave you.
"Changing the tube is dangerous, so we avoid it."
A planned change along a healed track is a short, practised procedure. What is dangerous is the unplanned change that happens when an old tube fails at night. Routine changes are the way to avoid that.
"We were taught once, so we can change it whenever."
Being taught the routine change does not cover changing the type or size, or a first change of a new kind. Those are for the clinic. If you are unsure whether a change is yours to do, ring first.
"A spare tube is a spare tube."
Every home should hold two spares: one the same size, one a size smaller. The smaller one exists for the day the usual size will not pass. Check both are in date, in their boxes, and within reach of the bed.
Being straight with you
What this page cannot tell you
This page cannot tell you the interval for your relative's tube, or whether you should be doing the change at home. Those depend on the make of tube, on how the stoma has healed, and on what the team has seen. The interval is printed by the maker and written on the discharge sheet.
Who should not be changing a tube at home
Anyone who has not done a change under supervision. Anyone caring for a person whose track is new, whose stoma is narrow or bleeds, or who is on a ventilator. Anyone whose last change in clinic was difficult. For all of these the change belongs in the clinic, and there is no shame in that.
What to ask at the clinic
How often is this tube changed, and who does it. What size is it, and what size is the smaller spare. Who do we ring at night if it comes out. Can the person be taught to change it themselves in time. Ask for the answers in writing and keep them with the spares.
If the tube that arrives from the supplier is a different make from the one on your sheet, ring the team before it is used.Questions we are asked
Common questions about changing a tracheostomy tube
Does a tube change hurt?
It is uncomfortable for a few seconds and usually brings on a cough, but it is not a painful procedure once the track has healed. Some people feel a scratchy soreness at the stoma for the rest of the day.
Why does the first change have to be in hospital?
Because the track is new, and if the new tube does not pass easily the team needs the equipment and skills to secure the airway another way. That happens rarely, but it is not something to meet at home.
Can the patient change it herself?
Many people with a long-term tube do, using a mirror, once they are strong enough and the team is satisfied. It is taught the same way as it is taught to a family member. Ask the tracheostomy nurse whether and when that would be right.
What if the tube comes out on its own?
Stay calm and put the spare in at once, the way you were taught, using the smaller one if the usual size will not pass. Then ring the team, even if it went in easily. An unplanned change always gets a call, because the team will want to know why it came out.
How many spare tubes should we keep at home?
Two at least: one of the same size and one a size smaller, both in their sealed boxes and within reach of the bed. Add a spare inner tube and a spare set of tapes. Replace any spare you use on the same day, before you need it again.
Does the old tube get reused?
Some makes are designed to be cleaned and reused a set number of times; others are single use. Your team will tell you which yours is. A reused tube is inspected each time for cracks, a stiff cuff line or a lock that no longer holds.
Will we be given the spares, or do we buy them?
You usually leave hospital with the tube that is in place and one spare. Further tubes are bought, and cost depends on the make. Ask the team where to buy them near your home, and whether your scheme or insurer covers them.
Is the change different for a metal tube?
The steps are similar, but metal tubes have no cuff, are often cleaned and reused for a long time, and some come with a pilot piece for insertion. Because the makes differ, follow the written instructions for your tube rather than a general page.
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Sources
- NHS — Tracheostomy
- National Cancer Institute — Tracheostomy (NCI Dictionary of Cancer Terms)
- American Cancer Society — Surgery for laryngeal and hypopharyngeal cancer
- Cancer Research UK — Laryngeal cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Accidental Tube DisplacementWhat to do when the tube comes out on its ownCuffed vs Uncuffed TubesWhy a change of tube type is a step forwardCleaning the Inner TubeThe daily job, as opposed to the monthly oneBlocked Tube: The Emergency Every Family Must KnowThe one change that cannot waitTracheostomy Supplies and Cost in HyderabadWhere to buy spare tubes and what they cost
Talk to us
Unsure who should be changing the tube, or when?
Call the helpline with the tube box to hand. A tracheostomy nurse or surgical oncologist will tell you what the interval means and what to ask your clinic. One helpline serves every CION centre.