A tracheostomy is a surgical procedure that involves making an incision in the neck in order to create an opening into the trachea. A tracheostomy tube is then inserted into the opening in order to provide an artificial airway to help a patient breathe.

In general, there are two different types of tracheostomy tubes:

  1. Fenestrated
  2. Non-fenestrated

There are several key differences between the two, and that is what we are going to discuss in this article. So, if you’re ready, let’s get into it.

What is a Tracheostomy Tube?

A tracheostomy tube is a cylindrical tube that is inserted through an incision in the neck and into the trachea. The tube has a hollow center, which allows air to pass through so that breathing can occur.

A tracheostomy tube is indicated when a patient is unable to breathe on their own or when they are in need of long-term mechanical ventilation. The tube helps to keep the airway open so that gas exchange can occur within the lungs.

Fenestrated vs Non-Fenestrated Tracheostomy Tube

There are a few key differences between fenestrated and non-fenestrated tracheostomy tubes. The primary difference is whether or not the tube has a fenestration, or a small hole, in the side of it.

Fenestrated Tracheostomy Tube

A fenestrated tracheostomy tube is a type that has an opening in the tube above the cuff, which allows air to enter so that the patient is able to speak with the tube in place.

A fenestration is simply a term that refers to the hole or opening in the shaft of the tube. Without said opening, no airflow can pass through the vocal cords, which means that the patient will be unable to speak with the tube in place.

Non-Fenestrated Tracheostomy Tube

A non-fenestrated tracheostomy tube is a type that does not have an opening in the shaft of the tube. This means that air cannot pass through the vocal cords with the tube in place, and as a result, the patient will be unable to speak.

Non-fenestrated tracheostomy tubes are generally the first type of tracheostomy tube that is inserted. However, if a patient is in need of long-term tracheostomy placement, a fenestrated tracheostomy tube is usually inserted in order to allow the patient to communicate.

Tracheostomy Tube Parts

All types of tracheostomy tubes are composed of several parts that make up the artificial airway, including:

  • Inner cannula
  • Outer cannula
  • Pilot balloon
  • Cuff
  • Flange
  • Obturator
  • Fenestration

Understanding the different parts of a tracheostomy tube is important in order to understand how the tube works and its overall function.

parts of a fenestrated tracheostomy tube

Tracheostomy Complications

There are a few potential complications that can occur with a tracheostomy, which include:

  • Infection
  • Incorrect positioning
  • Damage to the mucosa
  • Airflow obstruction
  • Accidental decannulation
  • Tracheomalacia
  • Tracheoesophageal fistula
  • Pneumomediastinum
  • Tracheal stenosis
  • Bleeding

While there are potential complications that can occur, it’s important to keep in mind that most are rare and can be avoided with proper tracheostomy care.

Fenestrated Tracheostomy Tube Suctioning

Tracheostomy tube suctioning is a therapeutic process that removes secretions from the trachea with the use of a suction catheter. This helps prevent the accumulation of secretions in the airways, which can lead to an obstruction and difficulty breathing.

When suctioning a fenestrated tracheostomy tube, it’s important to be aware of the opening in the side of the tube.

That is because the suction catheter can potentially go through the opening and cause damage to the tissues of the tracheal wall.

FAQ

What is the Difference Between a Fenestrated and Non-Fenestrated Tracheostomy Tube?

The primary difference between the two types of tracheostomy tubes is that a fenestrated tube has an opening in the side of the shaft, while a non-fenestrated does not. This opening allows air to enter so that the patient can speak with the tube in place.

How can you tell if a Tracheostomy Tube is Fenestrated or Non-Fenestrated?

The easiest way to tell if a tracheostomy tube is fenestrated or not is to look for the opening in the side of the shaft. If there is an opening, then it is a fenestrated tube. If there is no opening, then it is non-fenestrated.

When is a Fenestrated Tracheostomy Tube Indicated?

A fenestrated tracheostomy tube is generally indicated for patients who need long-term tracheostomy placement in order to allow them to communicate. Otherwise, a tube without a fenestration would leave the patient without a way to speak for a long period of time.

When is a Non-Fenestrated Tracheostomy Tube Indicated?

A non-fenestrated tracheostomy tube is usually indicated for patients who only need short-term tracheostomy placement. This is because the patient will not need to communicate while the tube is in place, and, as a result, a fenestration is not necessary.

What is a Shiley 6 Cuffless Fenestrated Tracheostomy Tube?

The Shiley 6 cuffless fenestrated tracheostomy tube is a specific type of tracheostomy tube that does not have a cuff. This is beneficial because it reduces the risk of damage to the tracheal wall.

Shiley is one of the leading manufacturers of tracheostomy tubs, and the number “6” refers to the size of the tube.

What is a Cuffed Fenestrated Tracheostomy Tube?

A cuffed fenestrated tracheostomy tube is a type of fenestrated tracheostomy tube that has a cuff. The cuff is inflated in order to create a seal between the tracheal wall and the tube.

This prevents air from leaking around the tube and helps position the tube in the airway.

Cuffed-Fenestrated-Tracheostomy-Tube

What Happens to a Patient with a Fenestrated Tracheostomy Tube?

A patient with a fenestrated tracheostomy tube will have an opening in the side of the neck where the tracheostomy procedure was performed. Without the tube in place, this opening is known as a stoma.

However, when the tube is in place, it serves as an artificial airway, which helps the patient move air into and out of the lungs. A fenestrated tracheostomy tube has an opening in the side of the tube that allows the patient to speak.

Final Thoughts

There are two primary types of tracheostomy tubes: fenestrated and non-fenestrated. The difference between the two types of tubes is that a fenestrated tube has an opening in the side of the shaft, while a non-fenestrated does not.

This opening allows air to enter so that the patient can speak with the tube in place. If you want to learn more, we have a comprehensive guide on tracheostomy tubes that I think you’ll find helpful. Thanks for reading!

Medical Disclaimer: This content is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you read in this article. We strive for 100% accuracy, but errors may occur, and medications, protocols, and treatment methods may change over time.

References

The following are the sources that were used while doing research for this article:

  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
  • Chang, David. Workbook for Chang’s Clinical Application of Mechanical Ventilation, 4th. 4th ed., Cengage Learning, 2013.
  • Rrt, Cairo J. PhD. Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 7th ed., Mosby, 2019.
  • Faarc, Cairo J. PhD Rrt. Mosby’s Respiratory Care Equipment. 10th ed., Mosby, 2017.
  • “Coblation of Suprastomal Granulomas in Tracheostomy-Dependent Children.” National Center for Biotechnology Information, 6 Mar. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5433249.
  • “Tracheostomy: From Insertion to Decannulation.” National Center for Biotechnology Information, Oct. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2769112.
  • Cheung, Nora. “Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes.” PubMed, June 2014, pubmed.ncbi.nlm.nih.gov/24891198.
  • “Are Fenestrated Tracheostomy Tubes Still Valuable?” PubMed Central (PMC), 1 Aug. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6802915.

Medical Disclaimer: The information provided by Respiratory Therapy Zone is for educational and informational purposes only. It should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition.