Trach Tubes

All About Various Types of Tracheostomy Tubes

Tracheostomy is a surgical procedure performed to create a hole in the front area of the neck into the windpipe. Then a tracheostomy tube is placed in this hole to keep it open for breathing. It provides a passage for breathing when the normal route of breathing gets blocked. A tracheostomy is performed when a health problem requires long-term breathing support from a machine or after a traumatic injury to the face or the neck.

When the tracheostomy is no longer needed, it is either left to heal naturally. It may be temporary or permanent.

Tracheostomy Tube Parts

Parts of a tracheostomy tube include:

1. The Hub

The part of the tube protrudes out of the patient’s neck. It has a universal diameter of 15mm so that it can connect with the ventilator circuit, resuscitation bags, speaking valves, and caps. Hence, any tracheostomy tube with a hub can fit these devices easily.

Some manufacturers keep the hub color-coded, so it is easier to identify tracheostomy tube sizes.

2. Outer Cannula

An outer cannula is the main part of the tracheostomy tube and is inserted into the trachea. It can be fenestrated, non-fenestrated, cuffed, or uncuffed. It comes in different sizes. Generally, the size of the cannula is shown on the flange as the outer diameter, which is the distance between the outside walls of the outer cannula and measured in millimeters. 

3. Flange/Neck Plate

It is a part of the tube that extends from the outer area of the tube. It should lie flush against the skin of the neck. The neckplate extends from both sides of the outer cannula and has holes to tie a strap around the neck.  

It has important information regarding the tracheostomy tube size, outer diameter, inner diameter, and cuff type. 

4. Tracheostomy Tube Tie

Tube tie keeps the tube in place and prevents accidental decannulation. It attaches to the flange through the side holes and wraps around the patient’s neck.  

One finger should be used to see if the tie is tight enough to prevent dislodgement. It should be noted that the edges may cause ulcerations if the tie is too tight. These ties should not be used if the patient recently had major neck surgery. 

5. Inner Cannula 

An inner cannula fits inside the outer cannula and prevents obstruction. It can be easily removed or replaced for cleaning. 

The size of the inner cannula should first be matched with the outer cannula to obtain a proper fit. Although the inner cannula comes packed with the tracheostomy tube, if required, it is available separately also. 

Some manufacturers keep them color-coded to identify the corresponding hub of the tracheostomy tube.  

6. Obturator

An obturator, also known as the pilot, guides the tracheostomy tube when inserted into the air passage. The inner cannula is removed, and the obturator is inserted, which extends a little beyond the tracheostomy tube. 

It has a blunt tip to avoid damage to the inner tissues. Soon after placement, the obturator is removed and replaced with an inner cannula. 

Different Types of Tracheostomy Tubes

There are three types of tracheostomy tubes - 

1. Cuffed Tracheostomy Tube

• Some tracheostomy tubes have a balloon-like attachment on the outer cannula. This attachment is called a cuff. 
• The cuff's role is to maintain the air delivered from the ventilator into the lungs. It blocks the space around the tube to prevent air from escaping from the normal air passage. For this to happen, the cuff is inflated. However, over-inflation may lead to an injury to the windpipe, making it important to monitor the pressure or volume of air or water in the cuff. A cuffed tube does not allow speech as the air cannot escape to the upper airway.
• A cuffed tracheostomy tube has a pilot line and a pilot balloon to indicate the cuff status. It has a spring-loaded valve that prevents the air from leaking out. A syringe is attached to this valve to inflate or deflate the cuff. If the pilot balloon is inflated, it means the cuff is inflated, and if it is deflated, the cuff is deflated, and the air can pass freely from the air passage.

2. Cuffless Tracheostomy Tube

• A cuffless or uncuffed tracheostomy tube does not have a cuff (the balloon-like attachment) at the end of the tube. It is used when it is unnecessary to monitor and measure the air from the ventilator, and the patient can tolerate the cuff deflation without any respiratory problems. Sometimes, these tubes are used for adult patients not on mechanical ventilation.
• The airflow differs from a cuffed tracheostomy tube. In the absence of the cuff, the air flows in and out from the tracheostomy tube, but there is a probability that the air may escape through the upper airway. Some speech is possible with this type of tube. The uncuffed tube does not have a pilot line and pilot balloon.

3. Fenestrated Tracheostomy Tube

• A single opening is called a fenestrate. A fenestrated tracheostomy tube has single or multiple holes in the curvature of the tracheostomy tube. This tube can be cuffed or cuffless. The openings in the tube allow airflow in the upper airway, allowing some speech even when the cuff is inflated.

The location of the fenestration is important. If it is closer to the tracheal wall, it may cause the proliferation of scar tissue. This scar tissue reduces the effectiveness of the openings, makes it difficult to pass a suction catheter, and complicates the removal of the inner cannula. 

While inserting and removing a tracheostomy tube into the stoma, extreme care should be taken. A dislodged tracheostomy tube could lead to complications. If the tube is not going inside, it should not be forced. Instead, try with a smaller tube or try re-inserting the old tube. During removal, ensure that the patient is relaxed and comfortable and does not hurt while removing the tube.

Where to buy tracheostomy tubes?

HPFY hosts a wide variety of different types of tracheostomy tubes. Some of our bestsellers are:

Tracheostomy Tube Sizes: Things To Remember

Tracheostomy tube sizes differ from brand to brand.

• Method of sizing - There are two methods for sizing various types of tracheostomy tubes.
  • Jackson sizing: Used for Shiley regular and Flex trach tubes only. The tube size does not refer to any actual measurement of the trach.
  • ISO (International Sizing Organization): Used by other tracheostomy supplies manufacturers. The tracheostomy tube refers to the inner diameter of the trach site (without the inner cannula)
• Cuffs matter - Understanding the type of trach cuff is crucial. Some of them include the following -
  • High Volume Low Pressure (HVLP)
  • High-Pressure Low Volume (HPLV)
  • Mid-Range cuffs
  • Fome-cuf
  • Tapered cuffs
  • Round cuffs
  • Barrel or cylinder shape cuffs
• Cuff leaks - The size of the cuff does not always correspond to or change with the size of the trach incision. To consider the ventilator leaks, check the diameter of the cuff when inflated. This diameter is also known as the resting diameter.
• Custom-made tracheostomy tubes - Manufactured based on the bedside measurements of the trach stoma.

Note: The outer diameter of the tracheostomy tube must be about two third to three fourth of the tracheal diameter. As a common rule, most adult females can accommodate a tube of 10 mm outer diameter, whereas most adult males require a tube of 11mm outer diameter.

HPFY also carries tracheostomy supplies like tracheostomy masks, suction machines and aspirators, tubes and tube holders, and other trach accessories. Check out our collection today!

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