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This section will discuss the components of tracheostomy tubes as well as different materials, cuffed, cuffless, and fenestrated tracheostomy tubes, and discuss the differences in function. Tracheostomy tubes facilitate positive pressure ventilation, allow for access for secretion removal, and provide a patent airway for patients with obstructed upper airways. Understanding the differences is essential for healthcare providers and caregivers involved in the care of individuals with airway and breathing disorders.
What is the tracheostomy tube?
A tracheostomy tube is a medical device inserted into a tracheostomy stoma (an opening in the neck that leads directly to the trachea) to maintain an open airway. Here are the key components of a tracheostomy tube:
Cannula - Consists of one hollow tube. The tube shaft is arc-shaped, facilitating proper alignment with the trachea.
Obturator - The obturator is a guiding device used during the insertion of the tracheostomy tube to ease the process. It fits inside the tube to provide a smooth surface that guides the tracheostomy tube as it is being inserted.
Neck Flange - The neck flange is attached to the outer end of the tracheostomy tube, and it helps secure the tube to the skin of the neck, preventing displacement.
Some tubes also have a balloon around the cannula inside the airway, called a cuff. This stops saliva and secretions from going in. This is usually only for older children.
The most commonly used tracheostomy tubes are made from polyvinyl chloride (PVC), silicone, or polyurethane. PVC softens at body temperature, conforming to patient anatomy and centering the tube in the trachea. Silicone is naturally soft and unaffected by temperature, resists colonization and biofilm buildup, and can be sterilized.
Who needs a tracheostomy?
All tracheotomies are performed to address a lack of air getting to the lungs. An emergency tracheotomy may be performed on a person with acute illness or traumatic injury that blocks their airway.
The most common reasons why a tracheotomy is performed are:
* Prolonged dependence on a ventilator for breathing
* To bypass an obstructed upper airway
* To clean and remove secretions from the airway
*To deliver oxygen to the lungs more easily or safely
How to Choose the Right Size?
The tracheostomy tube must be the right size for the patient. The ideal length of a tracheostomy tube is such that the tube tip lies a few centimeters above the carina. Tubes that are too long can cause trauma, discomfort, cough, and unilateral ventilation. Short tubes can result in ineffective ventilation, ulceration to the posterior tracheal wall, and displacement or dislodgement.
As a general rule, the outer diameter (OD) of a tracheostomy tube should be about 2/3 to 3/4 of the diameter of the trachea, to minimise trauma to the tracheal wall and allow the passage of gas around the tube to facilitate speech. A 10mm OD tube is appropriate for most adult females and 11mm for most males.
What is the common complication of tracheostomy?
Various complications are possible in the course of a tracheostomy. In general, bleeding, infection and granulation can cause problems at any time. Notable complications include: incorrect placement of the cannula, pressure ulcers in the area of the cannula tip, pneumothorax formation, tracheal wall damage due to cuff pressure errors, oesophageal fistula formation, scars and stenoses in the trachea.
Babies, people who smoke, and older adults have a greater risk of complications from a tracheostomy.
Note: It is essential for anyone performing tracheostomy tube suctioning to be adequately trained and familiar with the equipment and technique to ensure patient safety.
Tracheostomy tubes play a critical role in the management of patients requiring prolonged mechanical ventilation or those with airway obstructions.
However, their use requires careful monitoring and skilled management to prevent complications and optimize patient outcomes.
Healthcare professionals involved in the care of patients with tracheostomies must have a thorough understanding of these devices and adhere to best practices to ensure safe and effective respiratory support.
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