How to Change Twill Ties

Here are the steps you need to know for changing the twill tie for your child's tracheotomy tube:

• Ask a second person to help with tie change. The second person will hold the tracheotomy tube in place while the first person is changing the ties.
• If possible during the tie change, do not cut the old ties until the new ties are secured. Slide the soiled ties up or down to allow you to put the new ties on the flange at the same time.
• Cut two pieces of cotton twill tape long enough to fit around the neck and be tied.
• Cut at an angle to prevent fraying. Fold the angled end over about 1/2 inch and poke a small hole into the doubled end about 1/4 inch from the fold.
• Thread the tape through the hole of the tracheotomy tube flange from back to front. Pull the other end of the tie through the hole using the hemostats' or tweezers. Pull tightly while holding the tube. (This secures the tie to the tube without using knots and does not tug the tracheotomy tube from the child's neck.)
• Repeat the process for the other side of the tube. Bring both pieces of tie together and tie a square knot
• Check the new ties and see that only one finger can slide under the ties. The location of the knot should be moved each time it is tied to prevent skin breakdown. Flex the child's head slightly while tying to ensure the ties are secure in all positions. If irritation is noted on the neck, protection can be applied. This involves either placing a gauze pad at the point of rubbing or using different ties.
• Cut the old ties and remove them. Re-check the new ties to be sure that only one finger can slide between the ties and the neck. The second person must hold the tracheotomy in place as the first person secures the new ties. Secure the ties by tying three square knots.