Regarding Tracheostomy tube change
Tracheostomy tubes, frequently placed in critically ill patients who require prolonged airway access. It usually requires 7 days for maturation of the tracheal cutaneous tract. Changing tracheostomy tube prior to this may result in dissection between tissue planes, creating a false passage or lumen and loss of the airway. If situation arise to change tracheostomy tube before seven days (like due to cuff leak etc), it is always appropriate to keep backup measures with oxygen mask and endotracheal intubation in case tract get lost, desaturation or hemodynamic instability. Ideally, Bronchoscope should be kept handy too.
One trick in premature tracheostomy tube change is to do it over airway exchange catheter to avoid false lumen passage. You may use suction catheter, nasogastric tube or any tube to pass over.
The tracheostomy tube change: a review of techniques - British Journal of Hospital Medicine, Vol. 62, Iss. 3, 14 Mar 2001, pp 158 - 163