--- title: "Tracheostomy Tubes" description: "ENT notes on Tracheostomy Tubes." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/tracheostomy-tubes" categories: ["Short Questions in ENT", "Larynx and Trachea"] video: "https://www.youtube.com/watch?v=SXK6D7e8r5s" image: "https://media.theentresident.com/og-images/tracheostomy-tubes.png" --- # Tracheostomy Tubes ENT notes on Tracheostomy Tubes. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=SXK6D7e8r5s ## 🫁 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? πŸ‘‰ Incorrect tube size β†’ - Tracheomalacia - Tracheal stenosis - Tracheoesophageal fistula --- ### πŸ”§ 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 --- ### πŸŽ™οΈ Tracheostomy tube Accessories #### Tracheostomy tube Speaking Valve - One-way valve - Allows inspiration via tube - Expiration via upper airway β†’ **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** --- ### πŸ§ͺ Materials Used in Tracheostomy tube 1️⃣ **Polyvinyl Chloride (PVC)** - Disposable ❌ Bacterial retention β†’ 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 --- ### πŸ“š Types of Tracheostomy Tubes #### πŸ”© 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 > πŸ“š 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? --- #### πŸ” 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 --- #### πŸ—£οΈ 5- Fenestrated Tubes - Allow airflow around tube - Enable **speech** --- #### πŸ“ 6- Adjustable Flange (Extended Length Tubes) **Indications:** - Thick neck - Enlarged thyroid - Increased pre-tracheal tissue ❌ Lack inner cannula β†’ More secretion blockage --- #### πŸ‘Ά 7- Neonatal & Pediatric Tubes - Usually **uncuffed** - No inner cannula - Silicone preferred - Tube change every **week** --- ### πŸ“ Tube Size Selection #### Outer Diameter of Tracheostomy tube - Should be **2/3 to 3/4 of tracheal lumen** - Approx: - Female β†’ 10 mm - Male β†’ 11 mm #### Length of Tracheostomy tube - Tip should be **1.5–2 cm above carina** **Typical Length of Tracheostomy tube:** - Adult β†’ 60–90 mm - Pediatric β†’ 39–45 mm - Neonate β†’ 30–35 mm --- ## About This Note This free ENT note on Tracheostomy Tubes was written by Dr. Mausumi Das and is paired with a corresponding video lecture. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/tracheostomy-tubes When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## Related Notes by Category - Short Questions in ENT: https://www.theentresident.com/ent-notes-lectures/category/short-questions-in-ent.md - Larynx and Trachea: https://www.theentresident.com/ent-notes-lectures/category/larynx-and-trachea.md ## About The ENT Resident The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students. Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself. Browse all ENT notes and lectures on The ENT Resident: https://www.theentresident.com/ent-notes-lectures.md ## Medical-use Boundary The ENT Resident provides educational material for medical learning and revision. 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