Transtracheal catheters are used in oxygen therapy to provide a more direct and efficient method of delivering oxygen to patients with chronic respiratory conditions.
Constructed from durable polytetrafluoroethylene, these catheters are inserted into the trachea via a small incision in the neck. The placement process, facilitated under local anesthesia, is quick and minimally invasive.
This article will provide a comprehensive overview and explore the usage, benefits, and potential drawbacks of transtracheal catheters.
What is a Transtracheal Oxygen Catheter?
A transtracheal oxygen catheter is a medical device used to deliver supplemental oxygen directly into the airways. It’s inserted through a small incision in the neck and trachea, which allows patients with chronic lung conditions to receive a steady oxygen supply without the need for a nasal cannula or mask.
Image by BruceBlaus.
What is a Transtracheal Catheter Used for?
Transtracheal oxygen catheters are often indicated for home care and ambulatory patients, especially those requiring enhanced mobility or those who may find nasal oxygen devices uncomfortable or restrictive.
This system allows a steady flow of supplemental oxygen to be delivered directly into the windpipe via a small incision in the neck and trachea.
This eliminates the need for traditional nasal cannulas or masks, providing more comfort, increased freedom of movement, and potentially leading to improved adherence to oxygen therapy, consequently enhancing the patient’s quality of life.
- Lower oxygen use
- Less nasal and skin irritation
- Improved compliance
- Increased exercise tolerance
- Increased mobility
- Enhanced image
- High cost
- Surgical complications
- Risk of infection
- Mucus plugging
- Uncorrectable coagulopathy
- Terminal illnesses
- Lack of motivation or support
- Inability to return for follow-up
- Pleural herniation over the trachea
- Upper airway obstruction
- Mucus ball formation
- Subcutaneous emphysema
- Increased coughing
How Does a Transtracheal Catheter Work
A transtracheal catheter works by directly delivering oxygen to the patient’s lungs. The catheter, made of a durable material like Teflon, is inserted through a small incision in the lower neck and into the trachea or windpipe.
This is done with the aid of a small scope for accurate placement and to prevent complications.
Once installed, it’s connected to an oxygen supply via standard tubing. As the patient breathes, oxygen is delivered straight to the trachea and into the lungs, bypassing the upper airway.
This setup enables an efficient oxygen transfer, often requiring less oxygen flow compared to traditional oxygen delivery methods like nasal cannulas.
Procedure for Transtracheal Catheter Insertion
The procedure for the insertion of a transtracheal catheter is minimally invasive and typically takes 15 to 20 minutes under local anesthesia, thus eliminating the need for hospitalization.
It begins with the introduction of a small scope through the patient’s nose and into the windpipe, which allows the interventional pulmonologist to monitor the needle’s path.
This real-time visualization ensures the catheter’s accurate placement and helps avoid potential complications like bleeding or puncturing the posterior wall of the windpipe.
Once correctly positioned, the small, flexible catheter is passed from the lower neck directly into the trachea, establishing a direct channel for oxygen delivery to the lungs.
Transtracheal Catheter Flow Rate
The flow rate of a transtracheal catheter is up to 4 liters per minute. This is a manageable flow that ensures a steady supply of oxygen, adequate for the needs of most patients requiring long-term oxygen therapy.
Its relatively low flow rate contributes to its key advantage of not needing humidification, simplifying the overall oxygen therapy process.
FiO2 for a Transtracheal Catheter
The transtracheal oxygen catheter delivers a fractional inspired oxygen (FiO2) range of 22-35%. This allows a controlled and steady flow of oxygen directly into the windpipe.
This moderate FiO2 range caters to patients who need a constant oxygen supply but not at exceptionally high concentrations, making it a suitable option for long-term, chronic conditions.
Transtracheal Catheter vs. Nasal Cannula
A transtracheal catheter and a nasal cannula are both used to deliver supplemental oxygen, but they function differently.
The transtracheal catheter is a small, flexible tube that is inserted directly into the trachea through a small incision in the neck. This method delivers oxygen straight to the lungs, allowing for a lower flow rate and potentially reducing the need for humidification.
It can increase the patient’s mobility and comfort, especially for those who need continuous long-term oxygen therapy.
On the other hand, a nasal cannula is a device with two prongs that are inserted into the nostrils. It’s a less invasive method but typically requires a higher flow rate and can be less comfortable over extended periods, particularly causing dryness in the nasal passages.
However, it is easier to manage and has fewer complications than a transtracheal catheter. The choice between these two largely depends on the patient’s specific medical needs and lifestyle considerations.
Transtracheal Catheter vs. Tracheostomy
While both a transtracheal catheter and a tracheostomy involve accessing the trachea, they serve different purposes and involve different levels of invasiveness.
A transtracheal catheter is a small, flexible tube inserted into the trachea through the neck, specifically for delivering supplemental oxygen. It’s a less invasive procedure typically performed under local anesthesia, and the device can be installed in approximately 15 to 20 minutes without hospitalization.
This method improves mobility and comfort for patients requiring long-term oxygen therapy.
On the contrary, a tracheostomy involves creating a surgical opening (stoma) in the neck and trachea to insert a tube, facilitating breathing when the upper airway is blocked or when long-term mechanical ventilation is needed.
It’s a more invasive procedure requiring surgical expertise and is generally considered when less invasive airway support methods are ineffective or unsuitable.
Note: The choice between these procedures depends on the patient’s specific medical condition, the need for airway management, or long-term ventilation support.
FAQs About Transtracheal Catheters
What is Transtracheal Oxygen Therapy?
Transtracheal oxygen therapy (TTOT) is a method of delivering oxygen directly into the lungs through a tracheal catheter. It is used in treating chronic hypoxemia.
Who are the Common Patients for Transtracheal Oxygen Therapy?
While the vast majority are COPD patients, an increasing number of patients with severe interstitial lung disease (ILD) are being placed on transtracheal oxygen therapy. In some cases, patients awaiting lung transplantation are also put on transtracheal oxygen therapy.
What are the Benefits of a Transtracheal Catheter?
Transtracheal catheters provide several benefits, including direct delivery of oxygen to the lungs, which may be more efficient than traditional nasal cannulas or masks.
The lower oxygen flow required can extend the use of portable oxygen systems, making it a cost-effective solution for long-term oxygen therapy.
Additionally, as the catheter is discreetly positioned in the trachea, it allows for increased comfort and mobility, improving the patient’s quality of life.
What is the Meaning of Transtracheal Oxygenation?
Transtracheal oxygenation refers to the process of delivering supplemental oxygen directly into the trachea or windpipe. This is typically done via a small, flexible catheter that is inserted through the lower neck into the trachea.
Transtracheal oxygenation can improve the efficiency of oxygen delivery, particularly for patients requiring long-term or continuous oxygen therapy.
What is a Disadvantage of Transtracheal Oxygen Therapy?
While transtracheal oxygen therapy has many advantages, it also has potential drawbacks. One major concern is the risk of mucus build-up, which can obstruct the airway and cause serious complications.
Other risks include infection, bleeding, and damage to the tracheal wall. Additionally, the procedure to insert the catheter is more invasive than simply placing a nasal cannula or mask.
What if a Transtracheal Oxygen Therapy Patient Needs to be Intubated?
If an airway must be established, the individual performing the intubation should intubate over the transtracheal catheter.
The catheter is soft and pliable enough that no case of tracheal wall trauma has ever been published in the literature, even with the cuff inflated to the correct pressure.
What Happens if a Transtracheal Oxygen Catheter is Removed?
If the transtracheal catheter is removed, it will inevitably lead to the closure of the tract. This necessitates a repeat procedure for the patient, which is both costly and time-consuming for everyone involved.
How Often Should You Clean a Transtracheal Catheter?
In general, it is not a good idea for a catheter to be removed and reinserted for cleaning more than two times a day because this can induce trauma, such as tenderness or tracheal chondritis.
What is Transtracheal Augmented Ventilation (TTAV)?
Transtracheal Augmented Ventilation (TTAV) is the application of a heated and blended flow of oxygen at flow rates of 6-12 LPM through a transtracheal catheter. This can reduce the patient’s work of breathing.
What is a Transtracheal Catheter Made of?
The transtracheal catheter is made of a durable, versatile material known as Teflon, or scientifically, polytetrafluoroethylene.
This substance ensures its resilience and longevity for ongoing oxygen therapy applications.
Where is a Transtracheal Catheter Inserted?
The location of a transtracheal catheter is strategic; it’s positioned between the second and third rings of the trachea and secured with a special necklace, enhancing both comfort and efficacy.
Does a Transtracheal Catheter Require Humidification?
The low-flow nature of oxygen through the transtracheal catheter negates the need for humidification, simplifying the care process and reducing potential complications associated with moisture buildup.
While transtracheal catheters present certain potential risks, such as mucus obstruction or tracheal damage, their benefits can be substantial, particularly for patients requiring continuous long-term oxygen therapy.
The direct delivery of oxygen into the trachea reduces the necessary flow rate, extending the use of portable oxygen systems and improving the efficiency of oxygen delivery.
With careful management and appropriate patient selection, transtracheal catheters represent a promising alternative to traditional oxygen delivery systems, significantly improving the quality of life for many patients.
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.
- BruceBlaus, CC BY-SA 4.0, https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons.
- Siddiqui FM, Campbell S, Ie S, Biscardi F, Rubio E. Three decades of transtracheal oxygen therapy: A review of the associated complications with an illustrative case presentation. Lung India. 2017.
- Raimonde AJ, Westhoven N, Winters R. Tracheostomy. [Updated 2023 Jan 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.