Trach Exchange (Direct)

Last updated: February 9, 2026

Deepen anesthesia to ensure the patient does not cough. When inserting trach (probably cuffed if positive-pressure ventilation is needed), use the obturator (purple, tip sticks out the end beyond the trach) as this acts as a stylette of sorts and prevents the trach tip from catching soft tissue. Once in place, remove the obturator and instead place the inner cannula, which allows to ventilate.