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What are Tracheal Tubes?

Tracheostomy involves creating an artificial airway in a patient and inserting a tracheal tube through the stoma and the windpipe into the lungs to provide respiratory care. Trach tubes have three essential components – outer cannula, inner cannula and obturator. Also, there are three options in trach tubes to choose from-trach tube with cuff, uncuffed tracheal tubes and fenestrated trach tube. They are available in various sizes to allow the most comfortable fit. At Health Products For You, you will find high quality tracheal tubes and tube holders that help keep tracheal tubes in place thereby reducing the discomfort.

How Do Tracheal Tubes Work

Tracheostomy tube is meant to provide an alternative airway for breathing. It offers long-term ventilation and manages tracheal or bronchial secretions. A trach tube keeps secretions thin so as to prevent build-up of mucus plugs and facilitate comfortable respiratory therapy. It is inserted through the artificial opening made in the throat and inserted into the windpipe or trachea to open the restricted airway. The tube may be hooked up to a ventilator if the patient needs assisted breathing. It is then tied around the neck with the help of a trach tie or trach collar to keep it in place. Sometimes, valves are attached to the tube to allow speech by redirecting air flow.

What Are Tracheostomy Tubes Made Of?

Generally, tracheostomy tubes are made of plastic to provide maximum flexibility. There are tracheal tubes made of polyvinyl chloride which turns soft on coming into contact with the body temperature.You will also find trach tubes made of silicone which is soft and conformable. Then there are metal trach tubes but these are not very common and are available only in the uncuffed variety. Plastic and silicone are more commonly used for trach tubes because they are lightweight as well as allow minimum secretion crusting. The Portex Bivona AireCuf neonatal tracheostomy tubes are made of silicone which remains soft and flexible in the trachea. These pediatric trach tubes are soft and designed to be flexible and tender on babies’ tracheas.

Components of a Tracheostomy Tube

Trach tubes are available in dual cannula or single cannula types. A double cannula tracheostomy tube has two cannulas – inner and outer. Your selection will depend on your requirement. For infants and children, only single cannula is used and usually the cuffless variety.
  • Outer Cannula: It holds the tracheostomy open with the help of a neckplate or flange. Trach ties or trach collars are attached to holes in the neckplate and tied around the neck thus securing the outer cannula. This prevents the tracheal tube from slipping out of the stoma. Sometimes, the neck plate may even be secured to the neck with temporary sutures.
  • Inner Cannula: If you are using a dual cannula tube then it has an inner cannula which is inserted into the outer cannula. An inner cannula becomes essential for patients with a lot of secretions. If there is mucus build-up, the inner cannula can be brought out for cleaning making it easy to get rid of mucus plugs and, at the same time, allowing the outer cannula to provide the airway.The tube can then be re-inserted or replaced, depending on whether it is the disposable or reusable type. Once inserted into the outer cannula, the inner cannula is kept locked to prevent it from being coughed out.
  • Obturator: An obturator, which is also referred to as a pilot, is a device the sole purpose of which is to provide smooth insertion of the trach tube. It has a smooth exterior and is inserted into the trachea without causing tissue damage. Once the trach tube is guided through it, the obturator is then pulled out.

Types of Tracheostomy Tubes

There are two basic types of tracheostomy tubes – cuffed and uncuffed. A third less common type is fenestrated.

Cuffed Trach Tubes

Cuffed trach tubes are generally used for patients on a ventilator or for those who have difficulty swallowing. A cuffed tube is balloon- or barrel-shaped at the far end of the tube which, when inflated, blocks the airway to prevent air leaks and provide a seal. It directs the flow of air into the trach tube to provide complete ventilation. A cuffed tracheal tube also prevents the downward movement of secretions. The cuff is inflated with air, foam or sterile water through a device which is positioned outside the body. Cuffs can be low-pressure cuffs, high-volume cuffs, foam cuffs and tight-to-shaft cuffs. The Shiley Reusable Low Pressure Cuffed Tracheostomy Tube has a high-volume, low-pressure cuff to reduce the risk of tracheal damage.

Uncuffed Trach Tubes

Cuffless trach tube is suitable for those who are not on a ventilator. It allows some airflow around the tube which makes speech possible. Damage to tracheal wall is also prevented with cuffless tracheal tube. The Covidien Shiley disposable inner cannula tube is a cuffless, fenestrated tube designed to bypass upper airway obstructions and provide long-term ventilation.

Fenestrated Trach Tubes

Fenestrated trach tubes have an opening just above the cuff allowing the patient to breathe normally through the upper airway when the external opening is blocked. In a fenestrated tracheostomy tube, air flows upwards and through the vocal cords. Speech and cough is also possible through the mouth. There is also low risk of granulation tissue formulation. The Portex Blue Line is a fenestrated cuffless tracheostomy tube that conforms to the individual patient’s upper respiratory tract at body temperature.

Tracheostomy Care Instructions

  • Clean the inner cannula every day, at least once. If you do not have an inner cannula, you may skip this step.
    • Wash your hands and put on gloves.
    • Suction the trach
    • Remove the inner cannula. Clean the inside of the cannula and the outside of it. As advised, use hydrogen peroxide and a soft brush or pipe cleaner. Make sure all of the blood and dried mucus are removed.
    • Rinse the inner cannula with sterile saline and replace it into the outer cannula.  It should snap into place.
    • If you can not clean the cannula well, throw it away and use a new inner cannula.
  • Check the cuff strain once every day. You will be shown by your healthcare professional how to check your cuff pressure. Ask him how much air your cuff is meant to hold. You could need to apply air to your cuff or remove it from it. The cuff must contain the right amount of air. This will avoid problems with your breathing or damage to your airway.
  • Keep the trach tube away from water and other materials. Don't swim. Use a trach cap or mask when you take a shower or when you are swimming. This would stop the entry of water into your airway. Do not use powders or sprays near the trach tube.

It is generally recommended to change the tracheostomy tube once a week because it gets coated with dried secretions. This allows for hygienic care for your tracheostomy. Our collection of tracheostomy tubes includes products from top brands like Shiley, Provox, Portex, etc. We also carry tracheostomy tube holders which are comfortable and non-irritating on the skin. These allergy-safe trach collars limit movement of the tracheal tube. You can fix the tube holder in quick, easy steps using adhesive tapes, foam fabric, fastener tabs or Velcro closures.

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