Capping off of Tracheostomy tube

This refers to the complete occlusion of the tube in order to restore normal physiological breathing. This allows assessment of the patient to maintain their own airway without the tracheostomy tube prior to decannulation.  

Aim is to tolerate cuff deflation and speaking valve for 24 hours prior to capping off. 

Indication for capping off:

• Patients can fully tolerate cuff deflation (for at least 24 hours)

• Patients can cope with oral secretions

• Patients can get air past cuff and vocal cords when tracheostomy fully occluded

• Patients can tolerate temporary finger occlusion and speaking valve placement

A tracheostomy cap (see image below) covers the opening of the tracheostomy tube and blocks air from entering the tube. This forces the patient to breathe in and out through their nose and mouth. This is often the last step before the tracheostomy tube is removed (decannulation). If the tracheostomy tube can be capped for a certain time without any problems (ideally 4 hours), it is probably safe to be removed.

A cap must never be placed on any patient with an inflated cuff.

At King's our local policy states we should never cap a Tracheostomy tube that is a size 8 or greater. Therefore, we usually downsize our patients to a smaller tracheostomy tube as soon as we can, to facilitate weaning.