A tracheostomy is a surgical procedure that involves making an incision in the neck in order to insert a tube into the trachea. This is known as a tracheostomy tube, which is an artificial airway that helps a patient breathe.
In this article, we will provide an overview of tracheostomy tubes, including their types, uses, risks, and complications.
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What is a Tracheostomy Tube?
A tracheostomy tube is an artificial airway that is surgically placed directly into the trachea through an opening in the throat. It bypasses the upper airway as a means to establish a connection for breathing.
A tracheostomy is often performed when a patient is unable to tolerate intubation or if they are in need of long-term ventilatory support.
After a tracheostomy tube has been inserted, it is the responsibility of the respiratory therapist to maintain the tube in place and keep the incision site clean.
There are a number of reasons why a patient may need a tracheostomy tube. Some of the most common indications include:
- A patient who is unable to protect their airway
- A patient that will require long-term mechanical ventilation
- A patient who can’t manage their own secretions
- A patient who requires frequent tracheal suctioning
- A patient who has a difficult airway
- A patient with sudden trauma or swelling in their upper airway
- When intubation attempts have failed
Each patient is different, so the decision to place a tracheostomy tube is based on a number of factors specific to the individual.
There are several different types of tracheostomy tubes, including the following:
- Cuffed tracheostomy tubes
- Uncuffed tracheostomy
- Tracheostomy tubes with disposable inner cannulas
- Tracheostomy tubes with reusable inner cannulas
- Fenestrated tracheostomy tubes
- Tracheostomy tubes with a proximally extended length
- Tracheostomy tubes with a distally extended length
Each type of tracheostomy tube has its own advantages and disadvantages, depending on the needs of the patient.
Risks and Complications
There are a number of risks and complications associated with tracheostomy tubes, including the following:
- Damage to the larynx or trachea
- Obstruction in the tracheostomy tube
- Accidental decannulation
- Tracheoesophageal fistula
- Tracheal stenosis
While there are many risks and complications associated with tracheostomy tubes, most of them can be avoided with proper tracheostomy care.
What are the Parts of a Tracheostomy Tube?
In order to understand how a tracheostomy tube works, it’s important to know the different parts of the tube. The following are the most common parts of a tracheostomy tube:
- Outer cannula
- Inner cannula
- Pilot balloon
Understanding the different parts of a tracheostomy tube will help you understand how the tube works and how to provide the best care possible for your patients.
What is Tracheostomy Tube Suctioning?
Tracheostomy tube suctioning is a process of removing secretions from the trachea through the use of a suction catheter. This is done to prevent the buildup of secretions, which can lead to airflow obstruction and difficulty breathing.
In order to suction a patient with a tracheostomy tube, the following supplies are needed:
- Sterile suction catheter
- Vacuum source
- Sterile gloves
- Personal protective equipment
- Sterile water
- Sterile saline
- Collection chamber
Once all of the supplies have been gathered, the process of suctioning can begin. It involves the insertion of the catheter, which utilizes negative pressure from the vacuum source to remove secretions from the airway.
What is Tracheostomy Care?
Tracheostomy care is the process of cleaning and caring for the tracheostomy site to prevent infection and other complications. This includes gentle cleansing of the skin around the stoma, as well as the changing of the tracheostomy tube and inner cannula as needed.
Tracheostomy care is typically a job duty of respiratory therapists, although nurses are often involved in the process as well.
What is a Cuffed Tracheostomy Tube?
A cuffed tracheostomy tube is a type of tracheostomy tube that has an inflatable cuff around the distal end of the tube. The cuff is inflated to create a seal between the tube and the patient’s trachea. This helps to prevent air leaks and aspiration.
What is an Uncuffed Tracheostomy Tube?
An uncuffed tracheostomy tube is a type of tracheostomy tube that does not have an inflatable cuff. Uncuffed tubes are most often used in the neonatal population or for patients who can manage their own secretions.
What is a Fenestrated Tracheostomy Tube?
A fenestrated tracheostomy tube is a type of tracheostomy tube that has a small hole or fenestration in the side of the tube just above the cuff. The hole is placed over the patient’s vocal cords to allow them to speak.
What is a Capped Tracheostomy Tube?
A capped tracheostomy tube is simply a tube that has been covered or occluded with a cap. The cap prevents air from moving through the tracheostomy and forces the patient to breathe through their upper airway.
Caps are used to test if a patient will be able to breathe effectively without an artificial airway. This helps practitioners determine if the tracheostomy tube can be removed
Can you Talk with a Tracheostomy Tube in Place?
Whether or not a patient can talk with a tracheostomy tube in place depends on the type of tube that is being used. A fenestrated tracheostomy tube has a small hole in the side of the tube that is placed over the patient’s vocal cords, allowing them to speak.
With an uncuffed tracheostomy tube, patients may be able to speak if they are able to generate enough airflow through their upper airway. However, most uncuffed tubes are too small in diameter to allow for adequate airflow, and therefore patients are unable to talk.
Cuffed tracheostomy tubes have an inflated cuff around the distal end of the tube that creates a seal between the tube and the patient’s trachea. This prevents air leaks and aspiration but also blocks off the patient’s vocal cords, making it impossible for them to speak.
What is a Tracheostomy Collar?
A tracheostomy collar is a mask that fits over the tracheostomy tube that is used to provide oxygen and humidity to the patient. It functions like a typical aerosol mask used on patients who do not have a tracheostomy.
Tracheostomy collars and pressure support are two effective techniques to wean patients from mechanical ventilation.
A tracheostomy is a medical procedure that involves creating an opening in the neck in order to insert a tube into the trachea. The tube is then used to provide an artificial airway for the patient to breathe.
Tracheostomy tubes come in a variety of sizes and types, depending on the needs of the patient. There are cuffed and uncuffed tubes, as well as fenestrated and non-fenestrated tubes.
Caring for a tracheostomy site is important in order to prevent infection and other complications. This includes gentle cleansing of the skin around the stoma, as well as the changing of the tracheostomy tube and inner cannula as needed.
Hopefully, this article has helped you develop a better understanding of this topic. We have a similar guide on the process of intubation that I think you’ll find helpful. Thanks for reading!
John Landry, BS, RRT
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
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