Fenestrated vs. Non-Fenestrated Tracheostomy Tube (2023)

Tracheostomy tubes are pivotal in managing patients who require long-term airway support, often due to respiratory failure, airway obstructions, or other critical medical conditions.

A major distinction in tracheostomy tube types is between fenestrated and non-fenestrated designs. These classifications primarily relate to the presence or absence of holes (i.e., fenestrations) in the tube’s curvature.

Choosing the right type for a patient is crucial, as it impacts airway management, speaking ability, and the overall safety and comfort of the patient.

This article breaks down the differences, advantages, and potential drawbacks of each type, providing insights for healthcare professionals to make informed decisions.

What is a Tracheostomy Tube?

A tracheostomy tube is a curved tube that is inserted into a surgically created opening (stoma) in the trachea, or windpipe, to secure an airway.

It is used to aid breathing in patients who have difficulty maintaining an open airway, need long-term mechanical ventilation, or require frequent suctioning of secretions.

The tube bypasses the upper airway, allowing air to flow directly into the lungs, facilitating breathing and oxygenation.

Tracheostomy tubes can be temporary or permanent, depending on the patient’s medical condition and needs.

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

A fenestrated tracheostomy tube has small holes (fenestrations) in its curvature, allowing airflow through the vocal cords, facilitating speech, and weaning from mechanical ventilation. In contrast, a non-fenestrated tube lacks these holes, providing a continuous airway suitable for patients at risk of aspiration or needing a secure airway without speech considerations.

Fenestrated Tracheostomy Tubes

Fenestrated tracheostomy tubes have one or more small holes or fenestrations along the curvature of the cannula.

Advantages

• Speech: The fenestrations allow airflow through the vocal cords, enabling the patient to speak when the cuff (if present) is deflated and the tube’s proximal end is closed.
• Weaning: They can assist in the process of weaning a patient off of mechanical ventilation by allowing for increased airflow through the upper airway.

Limitations

• Aspiration Risk: If the cuff isn’t inflated properly or if there’s a mismatch in tube size, there’s a potential for aspiration of secretions into the lungs.
• Obstruction: The fenestrations can become obstructed by mucus or tissue granulation, potentially limiting airflow.

Non-Fenestrated Tracheostomy Tubes

Non-fenestrated tracheostomy tubes lack fenestrations and provide a continuous, unbroken lumen or passage.

Advantages

• Secure Airway: Offers a more direct and secure airway, especially beneficial for patients at a higher risk of aspiration or those who need consistent ventilation.
• Lower Maintenance: With no fenestrations, there’s less risk of obstructions from mucus or granulated tissue.

Limitations

• Speech: Patients may find it more challenging to speak because air cannot pass over the vocal cords as easily.
• Weaning: The absence of fenestrations means that airflow is limited to passing through the tube, which may complicate weaning efforts.

Note: When choosing between these two types, it’s essential to consider the patient’s clinical needs, the goal of airway management, and the expected duration of tracheostomy tube use.

Tracheostomy Tube Parts

A tracheostomy tube is made up of various parts, each designed for a specific function. Understanding these components is essential for proper care, maintenance, and troubleshooting of the device.

Here are the primary parts of a tracheostomy tube:

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

Note: These parts together form a tracheostomy tube, which is a critical device for patients requiring a direct airway to the trachea. Proper understanding and maintenance of these components ensure the tube functions effectively and safely.

Tracheostomy Complications

Tracheostomy, while a lifesaving procedure, can be associated with a range of complications, including the following:

• Bleeding: Minor bleeding is common after the procedure, but significant hemorrhage can occur from larger vessels and requires immediate intervention.
• Pneumothorax: The introduction of air into the pleural space can cause lung collapse. This may require a chest tube for management.
• Subcutaneous emphysema: Air can become trapped under the skin around the tracheostomy site, leading to a crackling sensation on palpation.
• Infection: Improper aseptic technique during the procedure can lead to local infections.
• Tube dislodgment: The tracheostomy tube can become dislodged, especially within the first 72 hours post-procedure before stoma formation.
• Tracheal injury or perforation: Direct injury to the tracheal wall can occur during insertion, potentially leading to mediastinitis (inflammation of the tissues in the mid-chest).
• Aspiration: Inhalation of saliva or other secretions can occur, especially if the tube’s cuff is not adequately inflated.
• Tracheomalacia: Chronic pressure from the tracheostomy tube can lead to softening of the tracheal cartilages.
• Granulation tissue: Over time, inflammatory tissue can form at the stoma site or within the trachea, which may obstruct airflow.
• Tracheoesophageal fistula: Although rare, a connection can form between the trachea and the esophagus due to chronic pressure from the cuff.
• Tracheal stenosis: Scarring can lead to a narrowing of the trachea, either at the stoma site or below the tube.
• Tube blockage: Accumulation of mucus or other secretions can block the tracheostomy tube.
• Difficulty with decannulation: Some patients might face challenges when trying to remove the tracheostomy tube due to complications like granulation tissue or tracheal stenosis.
• Scarring: Once the tracheostomy tube is removed, there can be noticeable scarring at the site of the stoma.

Note: It’s essential to monitor patients with tracheostomies closely and educate caregivers and patients about potential complications to ensure early detection and intervention. Proper technique during the procedure, meticulous post-operative care, and routine follow-ups can significantly mitigate the risk of these complications.

FAQs About Tracheostomy Tubes

How is a Fenestrated Tracheostomy Tube Different From a Non-Fenestrated Tube?

A fenestrated tracheostomy tube contains one or more small holes or fenestrations along its curvature. These fenestrations allow airflow through the vocal cords, which can facilitate speech and assist in weaning off mechanical ventilation.

A non-fenestrated tracheostomy tube lacks these fenestrations, providing a continuous and unbroken lumen for airflow.

How Can You Tell if a Tracheostomy Tube is Fenestrated or Non-Fenestrated?

By physically examining the tracheostomy tube, you can identify fenestrations as small holes in the tube’s curvature.

Additionally, product labeling and packaging often indicate whether the tube is fenestrated.

If still uncertain, consulting the manufacturer’s specifications or seeking guidance from a respiratory therapist or clinician can help clarify.

Why Would You Use a Fenestrated Tracheostomy Tube?

A fenestrated tracheostomy tube is often used for patients who are transitioning from full mechanical ventilation to breathing on their own.

The fenestrations allow the patient to breathe through both the tube and their upper airway, facilitating the weaning process.

Additionally, fenestrated tubes enable phonation by allowing air to pass over the vocal cords, helping patients speak while the tube is in place.

Why Would You Use a Non-Fenestrated Tracheostomy Tube?

A non-fenestrated tracheostomy tube provides a secure and continuous airway, making it suitable for patients who require consistent ventilation or are at a higher risk of aspiration.

Without fenestrations, there’s a reduced risk of secretions entering the lower airway, making it safer for those with compromised airway protection or during the initial post-operative period.

What is the Most Common Problem with Fenestrated Tracheostomy Tubes?

The most common issue with fenestrated tracheostomy tubes is the potential for the fenestrations to become obstructed by mucus, secretions, or granulation tissue.

This can impede airflow and make suctioning more challenging.

Additionally, there’s an increased risk of aspiration if the tube’s cuff (if present) is not adequately inflated.

What is a Shiley 6 Cuffless Fenestrated Tracheostomy Tube?

A Shiley 6 cuffless fenestrated tracheostomy tube is a specific type of tracheostomy tube manufactured by the Shiley brand. The “6” typically refers to the size (6 mm inner diameter).

Being cuffless means it lacks an inflatable cuff that would seal the trachea, and being fenestrated means it has holes in its curvature to allow for airflow through the upper airway and facilitate speech.

Can You Suction a Fenestrated Tracheostomy Tube?

Yes, you can suction a fenestrated tracheostomy tube. However, caution is required to ensure the suction catheter doesn’t inadvertently pass through the fenestrations, as this could cause trauma to the tracheal wall.

It’s essential to be gentle and aware of the tube’s fenestrated design during the suctioning process.

Can You Put a Speaking Valve on a Fenestrated Tracheostomy Tube?

Yes, a speaking valve can be placed on a fenestrated tracheostomy tube. The fenestrations allow air to flow over the vocal cords, facilitating phonation.

When a speaking valve is attached, it permits inhalation through the tracheostomy tube and exhalation through the fenestrations and past the vocal cords, enabling the patient to speak.

What is a Cuffed Fenestrated Tracheostomy Tube?

A cuffed fenestrated tracheostomy tube combines the features of a fenestrated tube with an inflatable cuff.

The fenestrations allow for airflow through the upper airway and vocal cord engagement, while the cuff, when inflated, ensures a sealed airway, especially beneficial during mechanical ventilation to prevent air leaks and reduce aspiration risk.

What Happens to a Patient with a Fenestrated Tracheostomy Tube?

When a patient has a fenestrated tracheostomy tube, they can breathe through both the tube and their upper airway due to the fenestrations.

This design facilitates the weaning process from mechanical ventilation and enables speech as air can pass over the vocal cords.

However, the patient also requires vigilant monitoring for potential complications, such as fenestration obstruction or aspiration.

The care plan would typically involve regular tube maintenance, potential suctioning, and, in some cases, the use of speaking valves or caps during the transition towards decannulation (removal of the tracheostomy tube).

Final Thoughts

The decision between fenestrated and non-fenestrated tracheostomy tubes is not one-size-fits-all but must be tailored to the individual needs and clinical status of the patient.

Fenestrated tubes offer the advantage of permitting phonation and easier weaning from mechanical ventilation, while non-fenestrated tubes provide a more secure airway, especially in patients with a high risk of aspiration or in the early postoperative period.

Understanding these nuances ensures optimal patient care, reduces complications, and facilitates better patient outcomes in the realm of respiratory management.