Before learning about tracheostomy tubes, we must understand what tracheostomy means, and what is it’s purpose. ‘Trachea’ refers to the windpipe present in your neck, and ‘ostomy’ means creating an artificial opening in an organ. So, tracheostomy definition is a surgical procedure through which the doctor makes an opening in your trachea or windpipe to open and clear it.
What are Tracheostomy Tubes?
The tracheostomy tube, also called the trach tube, is an instrument that your doctor puts into the tracheostomy opening to keep it patent and clear. Tubes are made from metal, rigid or flexible plastic, etc. Some tubes have to help patients who experience swallowing issues, while non-cuffed tracheostomy tubes are useful when there is no need for a ventilator.
The types of tracheostomy tubes depend on the neck’s shape, its size, the disorder you are suffering from, and the purpose of tracheostomy. Your healthcare professional will decide which tracheostomy tube is suitable for your condition.
Once put into place, the doctor will also explain how to take care of the tracheostomy tube and maintain it hygienically.
What are the Uses of Tracheostomy Tube?
Put a tracheostomy tube inside when you have some underlying disorder that makes it difficult to breathe. The use of the tube can be as follows:
- Blockages: Maybe you have swallowed something that has blocked your windpipe, cancer or tumours of the mouth and throat, some congenital disabilities, or any throat infection or injury that create blockages and make it difficult for the air to pass through to the lungs.
- Problems with the respiratory system: Some conditions that cause breathing difficulties and respiratory failures like pneumonia, stroke, head injuries, spinal cord injuries, and nervous system disorders can warrant tracheostomy so that the lungs get oxygen.
- Tapping the fluid from the airways: Sometimes, there is a buildup of fluid in the airways, which can cause difficulty in breathing. For instance, too much mucus buildup, especially if it is too sticky, can stop the air from entering the airways, causing breathing difficulties. Or if the airways fill up with blood due to injury can also lead to breathing problems. In such cases, tracheostomy removes mucus secretions or blood and frees up the airways.
Tracheostomy Types and Indications
There are various techniques through which your healthcare professional can perform a tracheostomy. There are different indications for each of these techniques. They are:
- Percutaneous tracheostomy: Usage of the technique is in the intensive care unit, done under local anaesthesia. The Seldinger method performs during a percutaneous tracheostomy and can finish at the patient’s bedside within half an hour. Experiencing respiratory failure and needing ventilation for seven days or more are the right candidates for percutaneous tracheostomy.
- Surgical tracheostomy: The surgeon performs surgical tracheostomy under general anaesthesia in the operation theatre. Surgical tracheostomy is preferred when the patient’s neck is short or fat, or maybe there are some arteries or veins that are at risk of getting punctured through other tracheostomy methods.
- Mini tracheostomy: A small non-cuffed tracheostomy tube helps perform a mini tracheostomy. It is indicated in the cases where the doctor has to suction out the secretions blocking the airways and in other emergencies where immediate ventilation is required.
Tracheostomy Tube Parts
Although several types of tracheostomy tubes, and usually a tracheostomy tube has six basic parts:
- Outer cannula: This is also called the tube shaft. It is available in various sizes and displays its diameter on the flange. The outer cannula forms the main part of the tracheostomy tube put inside the trachea. The outer cannula can be cuffed or non-cuffed, fenestrated or non-fenestrated.
- Inner cannula: Inner cannula comes with dual cannula tracheostomy tubes and has to be matched in size with the outer cannula to fit inside it snugly. It can be removed and cleaned or may be replaced if needed, thus offering easier maintenance. However, using an inner cannula reduces the amount of air inflow and increases the work of breathing. Single lumen tracheostomy tubes do not come with the inner cannula.
- A hub: Hub is the part of the tracheostomy tube extending out of the tracheostomy incision site. It fits into the ventilator, speaking valves, resuscitation bags, or caps and comes in a standard 15 mm diameter. Some tubes have colour-coded hubs to make identifying the tracheostomy size easier.
- A neck plate (flange): The neck plate protrudes out from the outer part of the tracheostomy tube and gets fixed to the tie. Also called flange, the neck plate displays the specifics of the tracheostomy tube, for example, the brand name, size of the tube, size of the inner and outer diameter, etc.
- Obturator (pilot): The obturator or the pilot helps your doctor insert the tracheostomy tube. Its ends are blunt to protect against any damage to the trachea during tracheostomy. Remove the obturator once the tracheostomy and place the inner cannula.
- Tracheostomy ties: A tie is a part of the tracheostomy tube attached to the flange and is tied around the patient’s neck to secure the tracheostomy tube. The tie comes in various materials like velcro ties, metal chain ties, twills, etc. Avoid a tracheostomy tie if the patient has undergone major neck surgery.
Tracheostomy Tube Types, Their Uses, and Their Sizes
The tracheostomy tubes need constant updates to reduce flaws in serving the purpose of tracheostomy. These come in various types and sizes. A 7-7.5 mm inner diameter tube is suitable for an adult female, while an adult male will need an 8-8.5 mm inner diameter tracheostomy tube. A 4-mm size is appropriate for children, and smaller sizes are good for neonates. Some of the types of tracheostomy tubes are as follows:
1. Single lumen tubes: The single lumen tracheostomy tube has only an outer cannula. The advantage of this type of tube is that it reduces airway resistance. However, if it gets blocked by mucus or any other blockage, change the entire tube, so it is imperative to check it for patency regularly through the suction catheter.
Single lumen tubes are used for paediatric purposes as the paediatric tube already has a small diameter and cannot accommodate an inner cannula.
2. Double lumen tubes: The most commonly used tracheostomy tubes have an inner cannula, and the whole tube does not need to be changed frequently as the inner cannula is changed if blocked. Connecting the tracheostomy tube is useful for the hub’s speaking valves or resuscitation equipment.
3. Uncuffed tubes: This tube does not have a balloon-like structure or a tracheostomy cuff. It is useful where there is no need to continuously monitor the volume of air going in or out of the lungs. The patient needs to detach the ventilation before putting in an uncuffed tracheostomy tube. This tube is usually suitable for neonates and paediatric patients.
4. Cuffed tracheostomy tubes: This is the one that consists of a balloon-like structure at the outer end of the tube. This balloon-like structure, called a cuff, is inflated with water or air as needed. These tubes are useful in an acute emergency for monitoring the volume of air going in and out of the lungs and the inflated cuff monitors.
5. Fenestrated tracheostomy tubes: These have single or multiple fenestrations (openings). It also has an upper part of the shaft. The main purpose of this fenestration or a window is to provide airflow. Due to this airflow, the patient can speak easily and cough out any mucus effectively. With a non-fenestrated type of tracheostomy tube, the patient will not be able to produce sound. If the patient is non-comatose and can verbalise and communicate, a fenestrated tube is a preferred choice. However, these openings sometimes irritate the tracheal mucosa and may lead to granuloma formation.
6. Adjustable flange tubes: These are tracheostomy tubes, which have a flexible flange or neck that helps adjust the tube’s length. The patients whose tracheas are set quite deep or have a fat neck need the additional size, and such patients are the right candidates for adjustable flange tubes. However, these are not for long-term use since the locking mechanism makes tracheostomy management difficult for such tubes.
7. Portex tracheostomy tubes: These are cuffed tubes. The soft thermosensitive material is useful in manufacturing the cuff. It takes the shape of the patient’s trachea, minimising any discomfort. The flange is flexible, which helps in easy cleaning of the tube. With the tube being transparent, your doctor can easily see if there is any mucus plug or other blockage or any soiling of the tube. It is also visible on the x-ray to ascertain its position. The tube provides a 15 mm connector that connects the ventilator or speaking valves.
What is the name of the tracheostomy tube?
The tracheostomy tube is also called the ”trach” tube.
What are the sizes of tracheostomy?
Different manufacturers have different sizes for measuring tracheostomy tubes. But the length varies according to the type of tracheostomy tube and the material. Generally, the inner diameter starts from 6 and goes up to 10.
What are the different types of cuffed tracheostomy and uncuffed one?
A cuffed tracheostomy tube has a balloon-like structure called a cuff at one end, while the uncuffed tracheostomy tube does not have a cuff.
What is the difference between an ET tube and a tracheostomy tube?
A tracheostomy tube and an endotracheal tube are both ways to connect your airways to a ventilator when needed. Nevertheless, an endotracheal tube is used for the short term, whereas you can use the tracheostomy tube for longer durations. The endotracheal tube passes into the lungs through the vocal cords, so speech is not possible on an endotracheal tube. Still, the doctor places the tracheostomy tube below the level of the vocal cords, freeing up the upper airway for addressing.