Tracheostomy Support: NDIS High Intensity Daily Personal Activities

Workers in the National Disability Insurance Scheme (NDIS) providing tracheostomy support must have specialised skills and knowledge. Tracheostomy care is a High Intensity Daily Personal Activity (HIDPA) carrying significant risks.

What is a Tracheostomy?

A tracheostomy is a surgically created opening, or stoma, through the front of the neck into the trachea. A tracheostomy tube may be inserted through the opening to provide an alternative airway, assist in removing secretions, or connect the person to ventilatory support. A tracheostomy may be temporary or permanent (Toker, Hayanga, Dhamija, Herron and Abbas 2020).

There are many different types and sizes of tracheostomy tubes. They may be cuffed or uncuffed, fenestrated or non-fenestrated, and may contain a removable inner cannula. Participants may also use equipment such as humidification devices, speaking valves, oxygen or mechanical ventilation. The type of tracheostomy and the participant's underlying condition directly affect how their support should be provided (ACI 2021).

Importantly, a tracheostomy is not the same as a total laryngectomy. People who have undergone a total laryngectomy have different airway anatomy and require a different emergency response (Talan, Kaufman, McGrath and Nunnally 2026).

Tracheostomy Management in the NDIS Practice Standards

Tracheostomy Management is set out in the NDIS Practice Standards under the High Intensity Daily Personal Activities Module.

This Practice Standard aims to ensure that NDIS participants with a tracheostomy tube in situ receive appropriate suctioning and management that is relevant and proportionate to their individual needs (NDIS 2021).

Under these standards, NDIS providers must meet the following quality indicators:

• Participants are involved in the assessment and development of a tracheostomy management plan. This plan identifies potential risks, incidents, and emergencies, as well as the actions needed to manage these situations, including escalation of care if necessary.
• The participant's health status is reviewed regularly (with their consent)
• Workers who provide tracheostomy care are informed by appropriate policies, procedures and training plans. These relate to the supports being provided to each participant
• Workers who provide tracheostomy care have received all necessary training that relates to each specific participant, either from an appropriately qualified health practitioner or a person who meets the expectations of the relevant skills descriptor
• Where a participant also requires ventilator support, the provider must ensure that workers meet the applicable requirements of the separate NDIS High Intensity Support Skills Descriptors for Ventilator Support

(NDIS 2021)

Being competent to perform suctioning or another individual task does not, by itself, mean that a worker is prepared to safely provide tracheostomy support. Workers also need to understand the participant's airway, normal presentation, equipment, risks, emergency plan and escalation arrangements (NDIS 2022; NSW ACI 2021).

Know the Participant's Tracheostomy

Tracheostomy support is participant-specific. Before providing support, workers should be familiar with information relevant to their role, including:

• Why the participant has a tracheostomy
• The type and size of the tracheostomy tube
• Whether the tube is cuffed or uncuffed, and the participant's usual cuff status
• Whether an inner cannula is present
• The participant's normal breathing pattern and respiratory presentation
• Their usual secretion amount, colour and consistency
• When suction is normally required, the prescribed method and depth
• Humidification requirements
• Oxygen or ventilation requirements, where applicable
• Communication methods and the use of devices such as speaking valves
• Whether the participant is able to breathe through their mouth and nose if the tracheostomy is displaced or removed
• Individual risk factors and known complications
• What actions are required if the participant's condition changes

(NDIS 2022)

The NDIS Skills Descriptors require the support plan to be current, readily available and clear about the participant's support needs, risks, emergency responses and equipment. Workers must also have access to appropriate supervision, support, consumables and additional workers where required (NDIS 2022).

Before Providing Tracheostomy Support

Before assuming responsibility for the participant's tracheostomy support, the worker should know:

What Support is Required

The participant's current support plan should describe the care to be provided and the worker's responsibilities.

What to Do in an Emergency

The worker should know the participant-specific response to airway obstruction, tube displacement, accidental decannulation, respiratory deterioration, significant bleeding and equipment failure.

How to Obtain Assistance

The worker should know who to contact for routine clinical concerns, urgent advice and emergencies. Workers need to know when and how to involve an appropriate health practitioner and understand the roles and responsibilities of others involved in the participant's tracheostomy support.

Where the Emergency Equipment is Located

Equipment required by the participant's plan should be immediately accessible and functional, including specialised emergency equipment, maintained together in a readily accessible emergency kit (NDIS 2022; ACI 2021).

Depending on the participant, an emergency tracheostomy kit may include:

• Suction equipment
• A spare tracheostomy tube of the same size and one size smaller
• Spare inner cannula where applicable
• Spare ties or securing equipment
• Other airway or resuscitation equipment specified in the clinical plan

(ACI 2021)

Workers should check, clean, and maintain suction and tracheostomy equipment in accordance with the participant's support plan and the manufacturer's instructions, and ensure that the required emergency equipment is complete, functional, and accessible.

Routine Tracheostomy Support

Tracheostomy care under the NDIS should be provided in accordance with the participant's current support plan, preferences, and the worker's documented training and competency.

Infection Prevention and Stoma Care

Support workers may be required to:

• Perform hand hygiene and use appropriate personal protective equipment (PPE)
• Maintain cleanliness around the tracheostomy stoma
• Provide dressing care where this is within their role and support plan
• Observe the surrounding skin
• Report redness, swelling, discharge, offensive odour, bleeding, pain, skin breakdown or other changes

(NDIS 2022)

Workers should follow required infection control procedures, including hand hygiene, PPE, waste disposal and the aseptic or clean technique specified for the particular procedure (National Health and Medical Research Council 2019).

Oral care is also an important aspect of infection prevention. Bacteria can build up quickly in the mouth, creating an ideal environment for harmful germs to grow. If a tracheostomy tube doesn't seal properly, these bacteria can leak into the lungs and cause a serious chest infection. Regular mouth care significantly reduces this risk (ACI 2021).

Humidification

Normally, the nose and upper airway warm, filter and humidify inhaled air. A tracheostomy bypasses much of its function. Inadequate humidification can cause secretions to become thick and difficult to clear and may contribute to tracheostomy tube obstruction (ACI 2021).

Humidification may be provided using devices such as a heat and moisture exchanger (HME) or an active humidification system. The participant's support plan should identify the required method and any worker's responsibility for checking or maintaining equipment. Humidification needs should be individualised based on the person's clinical condition and level of secretions (ACI 2021).

A change towards thicker, more difficult-to-clear secretions should not simply be regarded as a need for more suction. It may indicate inadequate humidification or hydration, a respiratory infection, or another change in the participant's condition, and should be managed according to the support plan.

Suctioning and Secretion Management

Suctioning is used when a participant is unable to adequately clear secretions from their tracheostomy. It is an invasive intervention and should be performed in response to clinical indications rather than automatically or according to a fixed schedule.

Support workers who perform suctioning must have participant-specific training and competency, and should know:

• The participant's indications for suction
• The correct equipment, catheter and prescribed suction settings
• How far the catheter is to be inserted, and what the participant normally tolerates
• What secretions usually look like
• When to stop the procedure
• When unsuccessful suctioning or abnormal findings require escalation

(NDIS 2022; Blakeman, Scott, Yoder, Capellari and Strickland 2022)

Excessively deep suctioning can cause damage to the airway, which is why suction depth and equipment should be determined as part of the participant's specific support plan rather than improvised by the worker.

Difficulty or inability to pass the suction catheter may indicate tube obstruction or displacement and should be treated as an urgent airway concern according to the participant's emergency plan. Workers should also report significant changes in secretion volume, colour, thickness, or odour, as well as new or unexplained bloodstained secretions (ACI 2021; NDIS 2022; Talan, Kaufman, McGrath and Nunnally 2026).

Inner Cannula Care

Some tracheostomy tubes contain a removable inner cannula. Secretions can accumulate within the cannula and restrict airflow. Routine assessment and appropriate cleaning or replacement of the inner cannula help reduce the risk of obstruction.

Where inner cannula care forms part of the worker's role, they should follow the participant-specific procedure for checking, cleaning, or replacing it, and ensure that the required spare equipment is available. A blocked inner cannula can contribute to partial or complete airway obstruction (ACI 2021; Swain 2025).

Cuffs and Speaking Valves

Workers should know whether the participant has a cuffed tracheostomy and the normal cuff status specified in the support plan. A cuffed tracheostomy may be required to facilitate positive-pressure ventilation or for other clinical reasons.

Excessive cuff pressure can cause tracheal tissue injury, while inappropriate cuff deflation may affect ventilation or increase other clinical risks. Cuff inflation, deflation or cuff-pressure management should therefore only be undertaken where this is specifically included in the support worker's role, and they have received appropriate training and competency assessment (ACI 2021).

Speaking valves are one-way devices that allow inhalation through the tracheostomy but direct exhaled air through the upper airway to assist speech. Their use requires an appropriately patent upper airway and a participant-specific assessment and management plan (Lian, Teng, Mao and Jiang 2022; ACI 2021).

A one-way speaking valve must not be applied to a standard cuffed tracheostomy while the cuff is inflated. If exhaled air cannot escape through the upper airway, severe respiratory compromise or death can occur.

Training and Competency

Workers providing tracheostomy support require both general tracheostomy knowledge and participant-specific training, as well as demonstrated competency. They should understand:

• The basic anatomy and function of the respiratory system, including the participant's individual airway anatomy and how their tracheostomy affects breathing, communication and secretion clearance
• Skin and stoma care
• The types, components and functions of equipment, including tube type, speaking valves, and emergency equipment and how to safely use them
• The participant's usual respiratory presentation and signs of deterioration, obstruction, displacement, infection and device malfunction
• Indications that suctioning is required and how it should be performed
• Requirements for monitoring, recording and reporting
• When and how to escalate concerns or activate the participant's emergency plan

(NDIS 2022; ACI 2021)

Competency should include both routine care and response to emergencies and complications. The NDIS Skills Descriptor recommends an annual competency review, with reassessment if the worker has not provided support for more than three months or if the participant's needs or support plan change (NDIS 2022).

Some aspects of tracheostomy care fall outside a support worker's scope and must be undertaken by an appropriately qualified health practitioner. This includes tracheostomy tie or strap changes, which should be performed by a qualified health practitioner with a second appropriately trained person, such as another health practitioner or support worker assisting (NDIS 2022).

Note: Tracheostomy care may differ between adults and children. Compared with adults, children have a much smaller, softer airway and may require different equipment, monitoring and emergency responses. Care should therefore be guided by a paediatric-specific support plan and training (Nickson 2026).

Recognising Deterioration and Tracheostomy Emergencies

Complications may occur at any stage while a tracheostomy is in place. Possible complications include:

• Tube obstruction, displacement or accidental decannulation
• Fistulae
• Infection of the stoma or respiratory tract
• Aspiration
• Tracheal injury or narrowing
• Formation of stomal or tracheal granulation tissue
• Skin or stoma breakdown
• Bleeding

(Swain 2025; ACI 2021)

Support workers are not expected to diagnose these complications. They must recognise changes from the participant's usual presentation, such as breathing difficulty, abnormal or blood-stained secretions, tube displacement, etc., and follow the participant's specific escalation or emergency plan (Swain 2025; ACI 2021).

Being able to identify the following signs of respiratory distress or deterioration is crucial for promptly and appropriately addressing an emergency situation:

(Adapted from ACI 2021)

Two particularly important emergencies are tube obstruction and tube displacement or accidental decannulation. Obstruction may occur due to thick secretions, mucus, blood or a blocked inner cannula. Displacement can occur even when the tube still appears to be sitting within the stoma. This means that visible tube position does not necessarily mean that it remains correctly positioned in the trachea (ACI 2021; Swain 2025).

Workers must follow the participant-specific emergency plan and must not attempt tracheostomy reinsertion or other airway procedures outside their training and assessed competency. Pushing a displaced tube back into place may create a false passage and further compromise the airway (ACI 2021).

Any airway or breathing changes are time-critical. The worker should stay with the participant, call for assistance and follow the participant's specific emergency plan.

Emergency services must be called when required by the plan, or if the participant has severe breathing difficulty, reduced responsiveness, or does not improve quickly following intervention. Workers should provide first aid, basic life support or CPR when required and within their training.

Conclusion

Knowing how to provide appropriate care to NDIS participants with a tracheostomy tube in situ is essential in preventing adverse consequences. Equally important is knowing when to escalate concerns and recognising the limits of the support worker's role. Safe tracheostomy support depends on understanding the participant's individual needs, following their specific emergency plan, and acting promptly when deterioration occurs.

For more information on this topic, see Ausmed's module Tracheostomy Support for NDIS Support Workers.