Tracheostomy Care: Care of the Inner Cannula

Care of the Inner Cannula

Some older children and teens have trach tubes with an inner cannula. Some inner cannulas are disposable (DIC: Disposable Inner Cannula). These should be changed daily, discarding the old cannula. Check with your equipment vendor regarding disposable cannulas.
For the reusable cannulas, the cannula should be cleaned 1 to 3 times a day and more often if needed. Do not leave the inner cannula out for more than 15 minutes.

Equipment

• 1/2 strength hydrogen peroxide
• Sterile water or normal saline
• Two clean or sterile containers (small bowl or cup)
• Inner cannula brush (tracheostomy brush or sterile pipe cleaner)
• Unfilled gauze pad
  
  Cleaning kits are available for inner cannula trach care. Check with your supply vendor.

Procedure

• Wash your hands.
• Explain procedure in a way appropriate for the child's age and understanding.
• Pour 1/2 strength hydrogen peroxide into a bowl or cup and normal saline or sterile water into the other.
• Open the gauze pad
• Remove the inner cannula
• Place the inner cannula into 1/2 strength hydrogen peroxide. Soak it for a few seconds and use the brush to clean secretions on the inside and outside of cannula.
• Place the cannula into normal saline or sterile water solution, soak and rinse.
• Dry off excess water with clean or sterile gauze pad.
• Suction through the outer cannula if needed.
• Replace inner cannula. Be sure the cannula is secure or "locked" in place in the trach tube.
• Wash your hands.

Cuffed Tracheostomy Tubes

 

Foam-filled Bivona cuff tracheostomy tube
deflated (left), inflated (right)

A cuff is a soft balloon around the distal end of the tube that can be inflated to seal the trachea for children needing ventilator support or to help prevent secretions from entering the lungs.
Avoid over inflating the tracheostomy tube cuff. The pressure of the cuff against the wall of the trachea can cause damage if it is too high. Two techniques that can be used to help avoid excess pressure are the minimal occluding volume technique and the minimal leak technique.
Suction the trach tube if needed. After suctioning the tube, suction the mouth and above the trach cuff so that secretions do not go into lungs when cuff is deflated.

Cuff Deflation Techniques

• Minimal Occluding Volume Technique: Deflate the cuff, then slowly begin re-injecting air (or sterile water depending on the type of tube) with a luer lock syringe. Place a stethoscope to the side of the child's neck near the trach tube. Inject air into the pilot line until you can no longer hear air going past the cuff. This means the airway is sealed. For children that are totally ventilation dependent, provide breaths with manual resuscitator. 
• Minimal Leak Technique: The same procedure as Minimal Occluding Volume, except that after the airway is sealed, slowly withdraw a small amount (approximately 1cc), so that a slight leak is heard at the end of inspiration.

Periodic measurements of the cuff volume should be noted and any changes reported to the doctor. A pressure manometer may be used to check cuff pressure on balloons filled with air. Generally, cuff pressure should be below 25 cm H2O.

 

Trach tube with cuff, pilot inflating balloon and pressure manometer
Illustration Source:
Kersten, L.D. (Ed.) (1998).  Comprehensive respiratory nursing:  A decision making approach.  Toronto:  W.B. Sauders Company.