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If you want to know if Intensive Care at Home can change a deflated tracheostomy tube for a ventilated adult or child at home, stay tuned. I will explain to you how we do that.

My name is Patrik Hutzel from intensivecareathome.com and I have a question today from a client who asks, “Can Intensive Care at Home change deflated tracheostomy tube for a ventilated adult or a child at home?”

Now, before I go through the procedure, let me give you some context. With Intensive Care at Home, obviously, we are providing 24-hour critical care nurses at home for ventilated adults and children with tracheostomies. We have emergency procedures for those, if a tracheostomy comes out or gets deflated or needs to be changed in an emergency, all of our nurses are critical care trained nurses, so they’re familiar with that procedure.

Now, this doesn’t happen very often. We’ve been in business since 2012, and it has happened once or twice where a tracheostomy tube either comes out for unforeseen reasons, or cuff tracheostomy really deflates and can’t be reinflated, and then the tracheostomy tube needs to be changed very quickly in order to ventilate a client or continue to ventilate a client because otherwise, there would be a leak.

So, let’s look at the actual procedure. So, changing a deflated tracheostomy tube for a ventilated client at home is a delicate and critical procedure. It should only be performed by a trained critical care registered nurse or by an intensivist or doctor familiar with tracheostomy tube changes. This is also what is documented in the evidence-based Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

So, how do you prepare? First of all, you need to ensure the need for a change and confirm the need for change by ensuring the tracheostomy is really requiring replacement, i.e., there’s a leak, the cuff is down, or worse, there’s a blockage, or whether it’s just routine maintenance.

Now, then you need to obviously have the new tracheostomy tube ready, either the same size, let’s just say for argument’s sake it’s a size 8, you need to have a size 8 tracheostomy tube ready and ideally also a size below, let’s just say a size 7 as a backup because what if you can’t get the size 8 back in, you need to put in a size 7. You need a sterile lubricant, you need sterile gloves, you need a suction catheter and a suction machine, you need an ambu bag, also known as a manual resuscitator or as an Air Viva ideally connected to oxygen, clean tracheostomy ties or holder, sterile water and saline for cleaning, also other emergency equipment such as spare tubes, forceps, tracheal dilators, and obviously, you need to make sure your ventilator  is working, make sure the ventilator is still on, and that it’s functioning properly. If you have time, place the patient in a comfortable supine position, slightly extend their neck if tolerated. Now, that is in in the ideal scenario.

Sometimes you don’t have time. I can tell you, we have done even some elective tracheostomy changes by patients sitting up. That’s all possible if they can sit up, if they’ve got an empty stomach, and so forth. Of course, maintain sterility, wash hands thoroughly, and use sterile gloves to prevent infection.

Now, let’s look at the actual procedure. Prepare the airway, pre-oxygenate the patient using the ventilator or ambu bag for 1 to 2 minutes to ensure they have adequate oxygen reserves, you can do that through the tracheostomy, or if the tracheostomy is already out, put a face mask on the face and the nose, close the tracheostomy or the stoma with a Tegaderm or an opsite dressing or a Comfeel dressing, and start bagging to re-oxygenate the patient. Also, suction the airway, suction any secretions to clear the airway and prevent obstruction during the procedure. Obviously, remove the old tracheostomy tube and carefully remove the tracheostomy ties or holder. Deflate the cuff if applicable using a syringe, gently withdraw the old tracheostomy tube while stabilizing the tracheostomy stoma. Only deflate the cuff if it’s not deflated already, but you should definitely check that the cuff is actually deflated, because otherwise it could cause trauma.

Then, insert the new tracheostomy tube, lubricate the new tube with sterile water or lubricant if needed. Gently insert the tube into the tracheostomy stoma following the natural curve, avoid forcing it. Confirm correct placement by observing chest rise, auscultating breath sounds, or checking ventilator settings, but also you need to inflate the cuff with the appropriate volume of air and avoid overinflation, of course, and then you got to check that with a cuff manometer. Then, attach clean tracheostomy ties to secure the tube or a holder to stabilize the tube. Ensure it’s  snug but not too tight, one finger comfortably fit under the tie. Sometimes two fingers is fine too.

Next, reconnect the ventilator, attach the ventilator tubing to the new tracheostomy tube. Verify proper ventilation by monitoring, oxygen saturation, chest rise, and ventilator parameters.

Now, what do you need to do once the patient is stable? Monitor the patient. Check for signs of respiratory distress such as decreased oxygen saturation, increased work of breathing or cyanosis, suction as needed to clear secretions.  Document the procedure, record the day, time, size and type of tracheostomy tube change, as well as any complications, dispose of used supplies, materials, and clean the area, and have emergency equipment ready. Of course, you need to have the same emergency equipment ready in case this happens again. Spare tracheostomy tube, same size and one size smaller, and resuscitation equipment nearby.

So, when would you need to call for help? Well, if you have difficulty inserting a new tracheostomy tube, of course. If the patient shows signs of respiratory distress or decreased oxygen levels that you can’t manage, bleeding or swelling around the stoma site and any signs of infection or worsening condition.

So, the problem in the home care environment is that if you call an ambulance, they often don’t know what a tracheostomy and the ventilator is. So really, our staff are trained to manage these emergencies or semi-emergencies. It shouldn’t really develop into an emergency. It should be handled calmly and confidently in those situations.

What is also important to know is that sometimes, a chest X-ray is necessary after tracheostomy exchange, and that can be done at home as well. There is a company in Sydney, Melbourne, Adelaide, Brisbane now, Mobile Radiology Mobile Imaging. Big shout out to the people there, they can do home X-rays, which is really great. So, all the resources are already there now in the community to manage those situations at home.

Now, with Intensive Care at Home, we’re currently operating all around Australia and we’re sending our critical care nurses into the home, 24 hours a day. Therefore, we are providing a genuine alternative to a long-term stay in intensive care for ventilation and tracheostomy, adults and children, Home BIPAP (Bilevel Positive Airway Pressure, Home CPAP (Continuous Positive Airway Pressure, ventilation without tracheostomy, tracheostomy without ventilation, Home TPN (Total Parenteral Nutrition, home IV potassium infusions, and home IV magnesium infusions. We’re also providing ventilation weaning at home. We’re also providing PICC (Peripherally Inserted Central Catheter) line management, central line management, Hickman’s line management, as well as port-a-cath management. We’re also providing nasogastric tube management and PEG (Percutaneous Endoscopic Gastrostomy tube management at home, we’re also providing palliative care at home.

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of going to an emergency department.

We’re therefore also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs around $5,000 to $6,000 per bed day. Our services costs around $2,500 to $3,000 per bed day and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families. So, it’s a win-win situation for all stakeholders.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We’re an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the Department of Veteran Affairs all around Australia. Our clients and we, as a provider, have also received funding through public hospitals, private health funds, as well as Departments of Health.

We are the only service provider in Australia that has achieved third-party accreditation  for Intensive Care at Home nursing in 2025. We have been achieving this high level of accreditation since 2012. No other provider has achieved this high level of accreditation in the community in Australia and has created more intellectual property for Intensive Care at Home nursing than we have. That puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do, which enables us to look after the highest acuity adults and children in the community in Australia safely.

We’re also the only service provider in Australia that provides evidence-based care. So, when you look at the Mechanical Home Ventilation Guidelines, for example, on our website that are evidence-based, we only exclusively send critical care nurses into the home with a minimum of two years critical care nursing experience. So, that means all of our nurses are critical care trained. Also, once again, Mechanical Home Ventilation Guidelines are evidence-based, it means only critical care nurses with a minimum of two years critical care nursing experience are safe to look after ventilated and tracheostomy clients in the community. That also includes tracheostomy clients without ventilation. That also includes patients on BIPAP and CPAP without tracheostomy, for adults and for children. It’s all evidence-based as you can see in the Mechanical Home Ventilation Guidelines.

Now, if you’re at home already and you’re watching this, and you realize that you don’t have the right level of support or you’re stuck in an ICU and you’re watching this, or you have a family member stuck in ICU, I’ll give you a very tangible example today. One of our first clients over 10 years ago was a client who was at home on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers cannot look after a client at home on a ventilator with a tracheostomy. That is like flying the airplane with the cabin crew instead of the pilot because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies or is at risk of dying if they don’t have critical care nurses at home looking after them 24/7, as is, once again, evidence-based and documented in the Mechanical Home Ventilation Guidelines on our website.

So eventually, this client found out about us. We were proving our concept Intensive Care at Home with this client very quickly. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never, ever went back into ICU ever again and we were proving our concept there very fast.

We can do the same for you if you’re not safe at home, which includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business.

This is also why we are providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS Support Coordinators, and we’ll put a link to an interview with Amanda in the written version of this blog below the video. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you’re an NDIS Support Coordinator or a case manager from another organization watching this, and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants, and you don’t know how to go about it and what evidence to provide, I encourage you to reach out to us as well. We can help you with the right level of funding and with the right level of advocacy. We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

If you are a critical care nurse and you’re looking for a career change, and you want to join a very progressive, dynamic, and high-performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined and you can join our high-performing team. If you are looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed the postgraduate critical care nursing qualification. We will be delighted to hear from you.

I have a disclaimer though, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients do want the same staff coming over and over again because our clients are so vulnerable and so special, and that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this will not be the right fit for you. We are looking for consistency and our clients are looking for consistency. So please, only apply with us if you can give us regular and consistent availability for shifts and you’re really keen on building relationships with us and with our clients.

If you are an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well. We can also help you eliminate your bed blocks in your ICU and in your ED for your long-term patients, or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is much more cost-effective than what you’re paying for in ICU and ED for.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, respiratory wards, please reach out to us as well. We can help you there fast.

If you’re in the U.S. or in the U.K. and you’re watching this and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and private nurses.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care, click the like button, click the notification bell, share this video with your friends and families, and leave your comments below, what you want to see next, what you think about today’s topic and what insights you have from today’s video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.

Take care for now.