Tracheostomy Tubes

🫁 Tracheostomy Tubes

A tracheostomy tube is inserted into the tracheostomy stoma to:

• Maintain a patent airway
• Provide ventilatory support
• Prevent aspiration
• Allow suctioning of secretions

What are the ideal characteristics of a Tracheostomy Tube?

👉 Incorrect tube size →

• Tracheomalacia
• Tracheal stenosis
• Tracheoesophageal fistula

🔧 Parts of Tracheostomy Tube

1️⃣ Outer Cannula

• Main body of tube inserted into trachea

• Tube size determined by inner diameter of outer cannula

2️⃣ Inner Cannula

• Removable tube within outer cannula

• Prevents secretion blockage

What are the different types of inner cannula?

3️⃣ Tracheostomy Tube Cuff

• Balloon at distal end

• Inflated after insertion

What are the functions of Tracheostomy Tube Cuff?

4️⃣ Pilot Balloon

• External balloon reflecting cuff inflation

What is the use of Pilot balloon in a Tracheostomy tube?

5️⃣ Neck Plate / Flange

• Supports tube

• Prevents inward displacement

• Has holes for ties or sutures

• Displays tube size/type

What is the difference between Flange in a Pediatric Tracheostomy tube and Adult Tracheostomy tube?

What is an Adjustable flange tube?

6️⃣ Obturator (Introducer)

• Inserted inside tube during placement

• Rounded atraumatic tip

• Removed immediately after insertion

What is the purpoze of Obturator in a Tracheostomy tube?

7️⃣ Fenestrations

• Holes on superior curvature

• Allow airflow through upper airway

• Facilitate speech and coughing

8️⃣ 15 mm Adaptor

• Connects tube to ventilator circuit

🎙️ Tracheostomy tube Accessories

Tracheostomy tube Speaking Valve

• One-way valve

• Allows inspiration via tube

• Expiration via upper airway → phonation

Can speaking valve be used with both uncuffed and cuffed tracheostomy tube? Why?

Occlusion Cap

• Blocks airflow through tube
• Used during decannulation trials

🎯 Functions of Tracheostomy Tube

• Prolonged positive pressure ventilation
• Protection from aspiration
• Bypass of upper airway obstruction
• Easy suction clearance

🧪 Materials Used in Tracheostomy tube

1️⃣ Polyvinyl Chloride (PVC)

• Disposable ❌ Bacterial retention → Short-term use

What are the Advantages & disadvantages of using Polyvinyl Chloride in Tracheostomy tube?

2️⃣ Silicone

• Less secretion adherence
• Less infection risk
• Sterilizable

⭐ Preferred in pediatric patients

3️⃣ Siliconized Polyvinyl Fluoride

• Thermosensitive

4️⃣ Metallic (Silver / Stainless Steel)

• Used in long-term tracheostomy
• Cannot connect to ventilator
• Contraindicated in MRI / Radiotherapy

5️⃣ Silastic (Silicone rubber)

• Less rigid

📚 Types of Tracheostomy Tubes

🔩 1- Metallic Tracheostomy Tubes

Examples:

• Chevalier-Jackson tube
• Fuller’s biflanged tube

Features:

• Double lumen
• No cuff
• Long-term use

What are the contraindications of Metallic Tracheostomy Tubes?

🧴 2- Non Metallic Tracheostomy Tubes

Examples:

• Portex tracheostomy tube (most common)
• Shiley tube

Features:

• Usually cuffed

• Short-term use

• Cost-effective

🎈 3- Cuffed vs Uncuffed Tracheostomy Tubes

Uncuffed Tracheostomy Tubes – Indications

• No mechanical ventilation

• Low aspiration risk

📚 To know the complete list of Indications of Uncuffed Tracheostomy Tubes, please purchase my notes.

What are the Contraindications of Uncuffed Tracheostomy tubes?

Cuffed Tracheostomy Tubes – Indications

• Positive pressure ventilation

• Aspiration risk

• Unstable patient

• Fresh tracheostomy

What are the Contraindications of cuffed Tracheostomy tubes?

What is the ideal cuff pressure that should be maintained in cuffed Tracheostomy tube?

What cuff pressure should not be exceeded in cuffed Tracheostomy tube? Why?

What are the complications of continued cuff over inflation?

What are the different specialised types of cuff available in cuffed Tracheostomy tube?

🔁 4- Single vs Double Lumen Tracheostomy Tubes

Single Lumen Tracheostomy Tubes

• No inner cannula

• Silicone preferred

• Less secretion adherence

Double Lumen Tracheostomy Tubes

• Inner cannula removable

• Reduces blockage

• Less frequent tube change

🗣️ 5- Fenestrated Tubes

• Allow airflow around tube

• Enable speech

📐 6- Adjustable Flange (Extended Length Tubes)

Indications:

• Thick neck
• Enlarged thyroid
• Increased pre-tracheal tissue

❌ Lack inner cannula → More secretion blockage

👶 7- Neonatal & Pediatric Tubes

• Usually uncuffed

• No inner cannula

• Silicone preferred

• Tube change every week

📏 Tube Size Selection

Outer Diameter of Tracheostomy tube

• Should be 2/3 to 3/4 of tracheal lumen

• Approx:

  • Female → 10 mm
  • Male → 11 mm

Length of Tracheostomy tube

• Tip should be 1.5–2 cm above carina

Typical Length of Tracheostomy tube:

• Adult → 60–90 mm
• Pediatric → 39–45 mm
• Neonate → 30–35 mm