Abstract: The present disclosure relates to a tracheostomy exchange system including a catheter comprising a distal end and a proximal end, a balloon fluidly coupled to the distal end of the catheter, and an adapter assembly removably coupleable to the catheter and configured to fluidly couple the balloon with the proximal end of the catheter when the adapter assembly is coupled to the catheter. When the adapter assembly is decoupled from the catheter, the balloon is fluidly sealed from the proximal end of the catheter. When the is inflated before the adapter assembly is decoupled from the catheter, the balloon can remain inflated while the tracheostomy is exchanged preventing aerosolization, protecting the lungs from bleeding and aspiration, allowing for effective oxygenation while preserving an access to the main airway.