A clinical reference for NDIS support workers, covering tube anatomy, routine stoma care, suctioning technique, infection control, NDIS Practice Standards compliance, and emergency decannulation response.
What Is a Tracheostomy?
A tracheostomy is a surgically created opening (a stoma) in the front of the neck that provides direct access to the trachea (windpipe), bypassing the upper airway entirely. A hollow tracheostomy tube is inserted through the stoma to maintain the airway and allow breathing.
Tracheostomies are performed when a person cannot breathe adequately through the nose or mouth, requires long-term mechanical ventilation, or cannot manage respiratory secretions effectively. For many NDIS participants, a tracheostomy is a permanent or long-term feature of their daily life, not a temporary post-surgical intervention. The support worker may be the only trained person present for most of the participant’s day.
Understanding the anatomy of the tracheostomy and the mechanics of the tube is the essential starting point for any support worker stepping into this role.
Key Components of a Tracheostomy Tube
Modern tracheostomy tubes consist of several interrelated components, each with a specific function:
- Outer cannula: the main tube that sits within the stoma and is secured by holder ties. It is not removed during routine care.
- Inner cannula: a removable lining tube inside the outer cannula. Secretions accumulate here; daily cleaning or replacement is the most common routine task for support workers.
- Cuff (on some tubes): an inflatable balloon that seals the tracheal walls, reducing aspiration risk and enabling mechanical ventilation. Cuff pressure must be monitored regularly.
- Flange (neck plate): the flat portion resting against the skin of the neck, through which holder ties are threaded to anchor the tube in place.
- Obturator: a rounded guide used during insertion; must always be kept accessible at the bedside for emergency reinsertion by qualified clinicians.
Tracheostomies in the NDIS Disability Context
Tracheostomies are significantly more prevalent in the disability population than in the general community. NDIS participants living with neurodevelopmental conditions, acquired brain injuries, spinal cord injuries, and progressive neuromuscular diseases frequently require long-term tracheostomy management as a core element of their daily support needs.
Critically, in the NDIS context this care is almost always delivered in community settings: the participant’s own home, a Supported Independent Living (SIL) dwelling, or a respite facility, rather than in a hospital. The clinical supervision provided by hospital nursing staff is absent. A disability support worker may be the sole trained person present for the entirety of a participant’s day, including at night. This reality underpins the seriousness with which training is approached in the NDIS framework.
Common conditions among NDIS participants requiring tracheostomy management include:
- Amyotrophic Lateral Sclerosis (ALS) / Motor Neurone Disease (MND): progressive weakening of respiratory muscles necessitating ventilatory support
- Duchenne Muscular Dystrophy: inadequate respiratory muscle function in later disease stages
- High-level spinal cord injury (C1–C4): often requiring permanent mechanical ventilation
- Traumatic Brain Injury (TBI): where swallowing and cough reflexes are impaired
- Cerebral palsy with severe bulbar involvement: chronic aspiration risk
- Congenital airway anomalies: tracheomalacia, subglottic stenosis in paediatric NDIS participants
Support Worker Responsibilities in Tracheostomy Care
A disability support worker’s role in tracheostomy management is precisely defined by the participant’s individualised Health Support Plan (HSP). That plan, developed by a registered nurse in consultation with the participant, their family, and their treating clinical team, details exactly which tasks the worker is authorised to perform, the specific technique required for this participant, what to document after each care episode, and the escalation pathway when something changes or goes wrong.
The breadth of support worker responsibilities typically spans three domains: routine daily care, ongoing observation and documentation, and emergency response. Each domain requires both clinical knowledge and practiced composure.
1. Routine Tracheostomy Care
Routine tracheostomy care is performed at least once daily and more frequently during illness or when secretion volumes are high. The overarching goals are to maintain airway patency, prevent infection at the stoma site, and ensure the participant’s comfort and dignity throughout.
Inner cannula management is typically the centrepiece of daily care. Secretions and dried mucus accumulate inside the inner cannula; if left unaddressed, this narrows the available airway lumen and increases respiratory effort. The standard approach involves removing the inner cannula, cleaning it with a tracheostomy brush and appropriate sterile solution, rinsing thoroughly under sterile water, and reinserting it, or replacing it with a fresh disposable cannula according to the participant’s supply protocol.
Stoma site care addresses the skin immediately surrounding the tracheostomy opening. The skin is cleaned with sterile gauze or swabs, secretions and dried crusting are gently removed, and a tracheostomy dressing (a pre-cut foam pad placed beneath the tube flange) is replaced. This dressing is changed at minimum daily, and immediately whenever it becomes wet or soiled.
Tracheostomy ties or holder are inspected and replaced when loose, soiled, or frayed. The fit should allow one finger to pass between the tie and the participant’s neck, secure enough to prevent accidental displacement, with no excess pressure that could damage skin or impair circulation.
2. Suctioning and Secretion Management
Tracheal suctioning (passing a sterile suction catheter through the tracheostomy tube to clear secretions the participant cannot expel through coughing) is one of the most clinically significant tasks within a support worker’s potential scope. It requires specific technique, sterile discipline, and clear clinical indication criteria.
Suctioning is indicated when observable signs suggest secretion build-up: audible gurgling respirations, visible mucus at the tube opening, increased respiratory rate or work of breathing, or declining oxygen saturation in monitored participants. Importantly, not all participants need regular suctioning. Some have effective coughs and manage secretions independently. The Health Support Plan specifies indication criteria and frequency for each individual.
Sound suctioning technique requires:
- Correct catheter size: generally no greater than half the inner diameter of the tracheostomy tube to preserve oxygenation during the procedure
- Suction applied only on withdrawal: never during insertion, to protect the tracheal mucosa from trauma
- Each pass completed within 10–15 seconds: to minimise hypoxia
- Recovery time between passes: with supplemental oxygen applied if prescribed
- Strict aseptic technique: sterile gloves, sterile catheter (one use only), sterile water for flushing
- Documentation: of secretion volume, colour, and consistency at each episode
3. Infection Control
Infection is the most frequent and most preventable complication of tracheostomy management in community settings. The stoma provides a direct pathway for pathogens into the lower respiratory tract, bypassing the natural filtration defences of the nose and throat. In the disability support context (where clinical oversight is intermittent rather than continuous), consistent, rigorous infection control practice is the single most protective intervention available to the support worker.
Core infection control practices for tracheostomy care include:
- Hand Hygiene: WHO 5 Moments of Hand Hygiene applies before and after all tracheostomy contact. Alcohol-based hand rub must be within arm’s reach at every care episode.
- Aseptic Non-Touch Technique (ANTT): Critical parts (catheter tip, cleaned inner cannula, sterile solution) must never contact non-sterile surfaces. Treat the sterile field as inviolable.
- Personal Protective Equipment: Sterile gloves for suctioning, non-sterile gloves for stoma care, apron and mask, particularly when the participant carries a multi-resistant organism (MRO).
- Environment Preparation: Clean, organised workspace before beginning. No interruptions during sterile procedures. Dispose of all single-use items immediately into a closed clinical waste bag.
- Stoma Site Assessment: Observe at every care episode for redness, warmth, swelling, purulent discharge, or pain around the stoma. Document and escalate any change from baseline.
- Equipment Management: Suction machines cleaned per schedule. Humidification chambers changed regularly. Expired, damaged, or contaminated supplies are discarded, never used.
NDIS Practice Standards and Legal Obligations
Under the NDIS Practice Standards and Quality Indicators, tracheostomy and airway management fall within the High Intensity Daily Activities (HIDA) module. This classification carries mandatory obligations for registered NDIS providers:
- Workers must complete verified training specific to the participant’s condition and support needs before delivering HIDA supports unsupervised
- An individualised, current Health Support Plan must exist for each participant receiving HIDA support, reviewed by a registered nurse at minimum annually or following any significant clinical change
- Ongoing clinical oversight by a registered nurse or credentialled health professional must be demonstrable, including an initial supervised competency period for new workers
- Worker training records and competency assessments must be maintained and accessible for audit purposes
- A clear incident escalation pathway must be documented and understood by all rostered workers
The NDIS framework does not permit a support worker to perform tracheostomy care outside the boundaries of a current Health Support Plan, regardless of how experienced they may be. This is not bureaucratic overhead; it reflects genuine clinical risk. A worker operating outside their authorised scope may expose themselves to serious legal and professional consequences, and more fundamentally, may inadvertently harm the participant in their care.
Recognising Signs of Respiratory Deterioration
One of the most clinically valuable competencies a disability support worker can develop is the ability to detect early signs of deterioration in a participant with a tracheostomy. Many serious complications (airway mucus plugging, tube displacement, aspiration pneumonia) are preceded by observable changes. Prompt recognition and escalation can prevent a minor concern from becoming a life-threatening emergency.
Routine Airway Patency Observations
At every care episode, the worker should note and document:
- Visible and audible airflow through the tracheostomy tube
- Chest rise and fall consistent with the participant’s established baseline
- Breath sounds, noting any new wheeze, crackle, or stridor (high-pitched inspiratory noise)
- Skin colour, noting absence of cyanosis (blue tinges) to lips, fingernails, and perioral tissue
- Participant’s self-report of comfort or distress (via communication aids where applicable)
Warning Signs Requiring Clinical Escalation
- Material increase in secretion volume, or change in secretion colour to yellow, green, or brown
- Secretion consistency that is thicker or more tenacious than the participant’s usual baseline
- Tracheostomy tube flange no longer sitting flush with the neck or tube appearing partially displaced
- Increased respiratory rate or visibly increased work of breathing (flaring nostrils, use of neck or shoulder muscles)
- New onset distress, agitation, or confusion in the participant
- Stoma site showing redness, swelling, warmth, or purulent exudate
- Unexplained fever (38°C or above) in the context of any respiratory concern
Emergency Response: Accidental Decannulation
Accidental decannulation (the unintended partial displacement or complete dislodgement of the tracheostomy tube from the stoma) is the most urgent emergency a tracheostomy support worker may face. Without the tube in place, the participant’s patent airway may be compromised immediately, and in individuals whose tracheostomy is well established, the stoma can begin to narrow within minutes as the surrounding tissue recoils.
Every support worker involved in tracheostomy care must rehearse and memorise the emergency response before their first solo shift. The steps below represent the standard response; the participant’s individual Health Support Plan may include additional participant-specific instructions:
- Stay calm. Stay with the participant. Call for help via mobile phone or an emergency call system without leaving the participant unattended.
- Call 000 immediately. Clearly state that a tracheostomy tube has been displaced and that you may have a patient with an airway emergency. Stay on the line.
- Maintain airway positioning. Position the participant per their Health Support Plan, typically sitting upright or semi-reclined. Avoid neck flexion.
- Do not attempt to reinsert the tube unless the Health Support Plan explicitly authorises this and you have been formally assessed as competent in emergency tube reinsertion by a registered nurse.
- Apply supplemental oxygen at the stoma opening if prescribed and available.
- Notify the on-call nurse or clinical lead per your provider’s incident escalation protocol simultaneously with, or immediately after, calling 000.
- Document everything as soon as the participant is stable: exact time of discovery, sequence of actions taken, response times of emergency services, and the participant’s clinical status at each point.
About the eMaster HUB Course
The Airway Management and Tracheostomy Care in Disability Services course from eMaster HUB was built specifically for the Australian disability workforce. It bridges the gap between hospital-based clinical knowledge and the community care realities that NDIS support workers actually navigate: homes, SIL dwellings, and respite environments, not wards staffed by full nursing teams.
The course content covers technical clinical procedure within the NDIS compliance framework, communication with supervising clinicians, documentation of care episodes, and person-centred principles for supporting participants whose tracheostomy is central to how they live, not just a medical detail.
| Course Detail | Specification |
| Course Fee | A$20.00 (one-time payment) |
| Duration | Approximately 1.5–2 hours (self-paced) |
| Delivery | 100% online, mobile and desktop compatible |
| Language | English |
| Certificate | Instant digital certificate issued on completion |
| Verification | Via the eMaster HUB Official Gateway |
| Access | Lifetime access to all course materials |
| Support | admin@emasterhub.com.au |
Curriculum Overview
- Anatomy and Physiology: Respiratory tract structure, tracheostomy function, tube types and their clinical applications.
- Routine Daily Care: Inner cannula management, stoma hygiene, dressing changes, tube tie inspection and replacement.
- Suctioning Technique: Indications, catheter selection, aseptic procedure, post-suction assessment, and documentation.
- Infection Control: ANTT principles, PPE selection, hand hygiene moments, equipment decontamination, MRO precautions.
- Observation and Documentation: What to assess, how to record, when to escalate, and how to communicate findings to clinical supervisors.
- Emergency Response: Accidental decannulation protocol, airway obstruction response, 000 procedures, and incident reporting.
Who Should Complete This Training?
This course is designed for any Australian disability support worker, community care worker, or allied health assistant who provides, or may be called upon to provide, direct care for an NDIS participant with a tracheostomy. It is equally relevant across several specific roles:
- New disability support workers: being onboarded to a role involving tracheostomy care for the first time, building foundational clinical knowledge before commencing supervised practice
- Experienced workers: seeking a formal, verifiable credential to document existing competency for their provider’s training records and NDIS audit files
- SIL facility teams: ensuring every rostered worker across a household has current, documented tracheostomy training, not only the primary carer
- NDIS providers: building a verifiable training portfolio ahead of NDIS Quality and Safeguards Commission certification or renewal audits
- Aged care workers: supporting older Australians with tracheostomies in home care or residential settings, where equivalent HIDA obligations apply
- Family carers: who provide substantial daily tracheostomy care and want a clinical framework to complement the guidance they receive from treating nurses
This course provides the foundational knowledge that makes practical competency assessments and daily care more effective and safer for both participant and worker. It does not replace the Health Support Plan, clinical supervision, or formal competency sign-off from a registered nurse, but it provides the essential substrate those processes build on.
Frequently Asked Questions
Can an NDIS support worker perform tracheostomy suctioning?
Yes, but only after completing verified, NDIS-compliant tracheostomy care training and under an active Health Support Plan developed by a registered nurse. The support worker must have documented evidence of clinical competency before performing suctioning unsupervised, and the participant’s Health Support Plan must specifically name this task within the worker’s authorised scope.
What is airway management in disability support?
Airway management in disability support is the structured set of practices used to maintain a clear, unobstructed airway for NDIS participants with complex respiratory needs. It encompasses tracheostomy care, secretion management, suctioning, participant positioning, supplemental oxygen administration (where prescribed), and emergency response to airway compromise.
How long does tracheostomy care training take for support workers?
eMaster HUB’s course takes approximately 1.5 to 2 hours to complete at a comfortable pace. It is fully self-paced, and learners can pause and resume across sessions. An instant digital certificate is issued immediately on completion, verifiable through the eMaster HUB Official Gateway with no waiting period.
Is tracheostomy care classified as a High Intensity Support under the NDIS?
Yes. Tracheostomy care and airway management are explicitly classified as High Intensity Daily Activities (HIDA) under the NDIS Practice Standards. Registered NDIS providers must ensure that all workers supporting these activities have documented, verifiable training, and that an individualised Health Support Plan is active and current for each participant receiving these supports.
What happens if a tracheostomy tube is accidentally displaced?
Accidental decannulation is a medical emergency. The correct immediate response is to call 000, stay with the participant, maintain their airway positioning as specified in their Health Support Plan, and do not attempt tube reinsertion unless you are specifically trained and authorised to do so. The eMaster HUB course covers the full emergency decannulation response protocol in detail.
Do I need a Health Support Plan before starting this training?
No. You can complete the eMaster HUB course at any time. A Health Support Plan is required before performing tracheostomy care tasks with a specific participant, but completing this training first means you arrive at that clinical planning conversation with the foundational knowledge to engage meaningfully and ask the right questions. Many workers complete it before their first tracheostomy assignment.
Is eMaster HUB tracheostomy training recognised for NDIS audit purposes?
eMaster HUB courses are developed by industry professionals with extensive experience in Australian community services and are aligned to NDIS Practice Standards requirements. The NDIS Quality and Safeguards Commission requires providers to demonstrate that workers have completed relevant, verifiable training. A verifiable eMaster HUB certificate contributes directly to meeting this documentation requirement during certification and audit processes.