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CION Cancer Clinics
Cleaning the inner tube of a tracheostomy | CION Cancer Clinics
The inner tube, or inner cannula, is a thin removable sleeve inside the main tracheostomy tube. Mucus dries onto it through the day. You take it out, swap in a clean spare, wash the dirty one and dry it for next time, so the main tube stays clear without being moved. At least twice a day, and more often when the tube sounds wet. This page shows you how. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is the inner tube, and why does it need cleaning?
- How do you clean the inner tube at home?
- What should you clean it with, and what should you never use?
- Reusable and disposable inner tubes, compared
- Four things families tell us, and what is actually true
- What this page cannot tell you
- Common questions about cleaning the inner tube
The short answer
What is the inner tube, and why does it need cleaning?
The inner tube, or inner cannula, is a thin removable sleeve that sits inside the main tracheostomy tube. Mucus dries onto it through the day. You take it out, clean it or swap it for a spare, and put it back, so the main tube stays clear without ever being moved.
Why it is there at all
The main tube is held in the windpipe by the stoma and the neck tapes. Taking it out to clean it would be a tube change every time, which is a bigger job. The inner tube solves that. Crust builds up on the inner sleeve, and the sleeve is the part you remove. Whatever is stuck to it leaves the airway with it.
How often
At least twice a day, and more often whenever the tube sounds wet, the person is breathing harder, or suction is being needed more than usual. In a hot, dusty month, or during a chest infection, that can mean every few hours. Your team sets the routine and will adjust it at each clinic visit. If the tube ever feels blocked, the inner tube comes out first, before anything else.
Not every tube has an inner cannula. If yours does not, this page does not apply, and your team will have shown you a different routine.Step by step
How do you clean the inner tube at home?
Get ready
Wash your hands. Lay out the spare inner tube, a small brush or pipe cleaner, and a bowl of cooled boiled water. Sit the person up and tell them what you are about to do.
Take it out
Hold the main tube steady with one hand. With the other, unlock the inner tube the way you were shown, usually a small twist, and draw it straight out. Expect a cough.
Put in the spare
Slide the clean spare in straight away and lock it. The person should never be left with the main tube open for longer than it takes to swap. Check that breathing is easy before you turn to the dirty one.
Clean the dirty one
Rinse it under running water, then run the brush through it until no crust remains. Hold it up to the light and look through it. A tube that is not fully clear is not clean.
Dry and store
Shake off the water and let it air-dry on a clean cloth, covered. It is now the spare for the next clean. Wash your hands again.
Not sure whether this applies to you?
Ask an oncologistThe practical part
What should you clean it with, and what should you never use?
Use
Cooled boiled water, or sterile water from the pharmacy. A soft brush, pipe cleaner or the cleaning swab the supplier provides. If the crust is stubborn, soak the tube for a few minutes before brushing.
Never use
Hot water, which can warp a plastic tube. Household bleach, antiseptic liquids, spirit or dish soap unless the team told you to. Anything sharp to scrape with. A brush that has been used for anything else.
Clean more often when
The tube sounds wet or whistles. Suction is needed more than usual. The weather is hot and dry, the fan is on all night, or the person has a cold. Mucus has turned thick or coloured.
Also check it
- Before sleep and first thing in the morning
- Before any long journey
- After a coughing fit that brought up a lot
Keep in the kit
At least two inner tubes of the right size, so there is always a clean one ready. A brush kept only for this. A covered container for the clean spare. Write the tube size on the lid.
!
One thing that cannot wait
If the person is struggling to breathe, or going blue around the lips, take the inner tube out at once. Do not stop to clean it. If breathing eases, put in the clean spare. If breathing does not ease with the inner tube out, the main tube may be blocked or out of place. Call the emergency number and start the blocked-tube steps you were taught. Do not delay to try cleaning again.
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Side by side
Reusable and disposable inner tubes, compared
Reusable inner tube
Disposable inner tube
Cleaned, dried and used again for weeks
Thrown away after one use, or after a day
Cheaper over time, more work each day
Dearer over time, quicker each day
Needs a brush, water and a place to dry
Needs a steady supply and a reliable shop
Usual choice for long-term tubes at home
Usual in hospital and for short-term tubes
Commonly believed
Four things families tell us, and what is actually true
"He sounds fine, so we clean it once a day."
A tube can be half blocked and sound normal until it is nearly closed. Twice a day is the floor, and looking through the tube is the test. If you can see through it clearly, it is clear. If you cannot, it was overdue.
"We boil the inner tube to sterilise it."
Boiling can soften and warp a plastic inner tube so it no longer locks. Cooled boiled water for cleaning is right. Boiling the tube itself is not, unless yours is a metal tube and the team said so.
"Taking it out makes her cough, so we do it less."
The cough is the airway reacting to being touched, and it passes in seconds. A blocked tube causes far worse than a cough. Warn her, be quick, and swap in the spare rather than leaving the tube open while you clean.
"Any inner tube of about the same size will do."
Inner tubes are matched to the make and size of the main tube. One from a different make can fail to lock, sit loose, or narrow the airway. Buy the exact one printed on the box, and keep the box.
Being straight with you
What this page cannot tell you
This page cannot tell you how the lock on your particular tube works, whether your inner tube is reusable, or how many times a day your relative needs it cleaned. Those come from the tube box and from the nurse who showed you on the ward.
Who this routine does not suit
Anyone whose tube has no inner cannula, where a blocked tube means a tube change instead. Anyone on a ventilator at home, where the team arranges a different routine. And a carer who has not yet done it under supervision. Ask to do the first two cleans yourself on the ward, with the nurse watching, before discharge.
What to ask before you go home
Is the inner tube reusable, and for how long. How many spares are we being sent home with, and where do we buy more. What exactly do we clean it with. What do we do if it will not come out, or will not lock back in. Ask for the answers in writing and photograph the sheet, so it is on every family phone and not only in one person's memory.
If the inner tube will not come out with gentle pressure, do not force it. Ring the ward or the helpline.Questions we are asked
Common questions about cleaning the inner tube
How long can the main tube be left without an inner tube?
Only as long as it takes to swap in the clean spare, which should be seconds. That is why you always have a clean spare ready before you take the dirty one out. The main tube left open for a long stretch collects crust at its own tip, which is much harder to clear.
Can I use tap water?
Rinse under the tap, but do the final rinse with cooled boiled water or sterile water. Tap water in many parts of Telangana carries organisms that are harmless to drink and unwelcome in the airway. If you are unsure of your supply, boil and cool a jug each morning.
The crust will not come off. What now?
Soak the tube in cooled boiled water for a few minutes and brush again. If crust is building this fast, the air is too dry, and the fix is better humidification rather than harder scrubbing. Never scrape with anything sharp. A scratched tube collects more crust next time.
How do I know when the inner tube needs replacing?
When it no longer locks firmly, when it looks cloudy, cracked or bent, or when the supplier's stated life has passed. Ask the team how long yours is meant to last. Keep the box, because the exact make and size are printed on it.
Should the patient learn to do this himself?
Yes, if the hands and eyesight allow it. Many people manage it with a mirror within a few weeks and prefer the independence. Ask the tracheostomy nurse to teach the patient as well as the family, so nobody is stuck if the usual carer is away.
Is it dangerous if I forget a clean?
A single missed clean in someone with thin secretions is usually nothing. The danger is a pattern of missed cleans, or a missed clean during a chest infection when mucus is thick. Set a phone alarm for morning and night until it becomes habit.
Do I need gloves?
Washed hands are what matters at home. Gloves are fine if you prefer them, and useful during a chest infection, but they do not replace hand-washing. Wash before and after every clean.
Does a metal tube follow the same routine?
The steps are the same. Some metal tubes can be boiled, which plastic ones cannot, and some come with a pilot piece for putting the outer tube back. Because the makes differ, follow the written instructions for your tube rather than a general page.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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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
- Macmillan Cancer Support — Head and neck 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
The Parts of a Tracheostomy TubeWhere the inner tube sits and how it locksHumidification and Preventing CrustingWhy crust forms and how to make less of itSuctioning at Home: How to Do It SafelyThe other daily job that keeps the tube clearBlocked Tube: The Emergency Every Family Must KnowWhat to do when taking the inner tube out is not enoughTracheostomy Supplies and Cost in HyderabadWhere to buy spare inner tubes
Talk to us
Going home with a tracheostomy and not sure of the routine?
Call the helpline. A tracheostomy nurse or surgical oncologist will go through the cleaning plan with you and tell you what to ask the ward before discharge. One helpline serves every CION centre.