A Tracheostomy is a surgical opening in the neck and trachea that provides access for the insertion of an artificial airway known as a Tracheostomy Tube.

In general, there are Fenestrated and Non-Fenestrated Tracheostomy Tubes. In this article, we are going to break down the differences between the two.

When is a Tracheostomy Indicated?

A Tracheostomy is usually indicated when a patient has a condition which will require long term ventilation.

A surgical opening, called a stoma, is made in the anterior part of the throat. This is where an artificial airway can be inserted to assist with mechanical ventilation. 

What is a Tracheostomy Tube?

A Tracheostomy Tube is a device that fits into the stoma and provides reliable airway access that can be used for long-term ventilation. It helps prevent injuries to the tissues in the throat that commonly occur when an Endotracheal Tube is used.

Keep in mind that a Tracheostomy Tube may be placed immediately in some cases. For example, if a patient has thoracic or cervical spine injury that has led to paralysis. Also, it would be needed in cases where an Endotracheal Tube can’t be used.

Parts of a Tracheostomy Tube:

Tracheostomy tubes can be curved or angled. They come in different lengths and sizes in order to find the right fit for an individual’s anatomy. Here are the parts of a Tracheostomy Tube:

  • Outer Cannula
  • Inner Cannula
  • Shaft
  • Faceplate
  • Fenestration
  • Cuff
  • Pilot Balloon

What is a Fenestrated Tracheostomy Tube?

It’s a Tracheostomy Tube that has an opening above the cuff which allows airflow to pass through so that the patient is able to talk with the airway 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.

What is a Non-Fenestrated Tracheostomy Tube?

It’s a Tracheostomy Tube without an opening (fenestration). Again, the opening is required in order for the patient to produce sound with their voice.

Therefore, a patient with a Non-Fenestrated Tracheostomy Tube will not be able to speak.

Fenestrated vs Non-Fenestrated

There are times when a Fenestrated Tracheostomy Tube is preferred and is a necessity over a Non-Fenestrated Tube. In general, if the patient is alert and able to communicate, a Fenestrated Tube would be prefered.

With that said, there are some complication of using a Fenestrated Tracheostomy Tube. For example, the edges of the opening can cause irritation to the tissues of the trachea wall. This can cause a callous to occur with is referred to as a granuloma.

Fenestrated vs Non-Fenestrated Tracheostomy Tubes Vector

Final Thoughts

Ultimately there will be several factors that decide if a fenestrated tube over a non-fenestrated tube. The patient’s well being and what is best for that patient’s situation is always the utmost concern when making that decision.

Hopefully this overview has helped you learn the differences and similarities between Fenestrated and Non-Fenestrated Tracheostomy Tubes.

Be sure to check out our detailed guide on Airway Management. Thank you so much for reading and as always, breathe easy my friend.

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. [Link]
  • Chang, David. Workbook for Chang’s Clinical Application of Mechanical Ventilation, 4th. 4th ed., Cengage Learning, 2013. [Link]
  • Rrt, Cairo J. PhD. Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 7th ed., Mosby, 2019. [Link]
  • Faarc, Cairo J. PhD Rrt. Mosby’s Respiratory Care Equipment. 10th ed., Mosby, 2017. [Link]
  • “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.

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