Explain to your child what you will do, then set up what you need in a clean, well-lighted space near a sink. Gather the following: suctioning supplies, because you will likely suction before you change the trach tube, clean, disposable, powderless gloves, normal saline solution, trach ties cut to the correct length, a new trach tube with an obturator, two sterile or disposable cups, clean cotton swabs, and a small towel for the child's neck. Be sure to also have a resuscitation bag in case of emergency. Wash your hands. Put on disposable gloves. Remove the new trach tube. Move the obturator back and forth in the trach tube to be sure it will slide out easily. Put a rolled up towel under your child's neck. Undo the trach ties. If the ties need to be replaced, place the new trach ties under the child's neck. Lift the old tube just enough to clean under it. Use cotton swabs dipped in sterile saline. Use each end of a cotton swab only once. Do not dip it back into the saline solution. Have the new trach tube ready. Then remove the entire old trach tube and lay it down on a towel. Immediately insert the new trach tube. Hold the edges of the tube and remove the obturator as quickly as possible. Your child cannot breathe while the obturator is in place. Secure the trach ties. When you're done, throw away the gloves and wash your hands.
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