Tracheostomy

Indications for Tracheostomy

  • xxxx

Brands of Tracheostomy Tubes

Cuffed Non-Fenestrated

Shiley (Covidien)

  • Size 6
  • Size 8

Portex

  • General Features of Portex Suctionaid Traceostomy: has subglottic suction port

  • Suctionaid 6
  • Suctionaid 7
  • Suctionaid 8

Bivona

  • xxxx

Cuffed Fenestrated

  • xxx

Tracheostomy Sizing Comparison

  • Note: Portex = Portex Suctionaid

Portex Size|Inner Diameter|Outer Diameter|Length
:————-:|:————-:|:—————:|:————:
Size 6|6 mm|9.2 mm|64.5 mm
Size 7|7 mm|10.5 mm|70 mm
Size 8|8 mm|11.9 mm|75.5 mm
Size 9|9 mm|13.3 mm|81 mm

Shiley Size|Inner Diameter|Outer Diameter|Length
:————-:|:————-:|:—————:|:————:
Size 4|5 mm|9.4 mm|62 mm
Size 6|6.4 mm|10.8 mm|74 mm
Size 8|7.6 mm|12.2 mm|79 mm
Size 10|8.9 mm|13.8 mm|79 mm


Passy-Muir Valve

  • The Passy-Muir valve permits inspiration but not exhalation via the tracheostomy tube and, when the trach cuff is deflated, exhaled air is thus directed up through the glottis, permitting phonation
  • The Passy-Muir valve is usually well-tolerated and can be used in patients with neuromuscular disease

  • Requirements for Passy-Muir Valve Use:

    • Ability to Clear Secretions:
    • Adequate Gas Exchange:
    • Hemodynamic Stability:
    • Normal Mental Status:
  • Advantages of Passy-Muir Valve:

    • Aspiration During Eating is Reduced: as it restores more normal subglottic and glottic airflow during exhalation
    • Decrease in Amount of Bronchial and Pharyngeal Secretions: because air escaping through the mouth and nose contributes to their evaporation
    • Improved Cough Effectiveness: because of the restoration of glottic function
    • Reestablishment of the Ability to Smell:
  • Complications of Passy-Muir Valve:

    • Inappropriate use of excessively large trach -> impedes expiratory airflow through trachea
    • Accidental use with trach with cuff still inflated -> completely obstructs expiratory airflow

Tracheostomy Configurations

TRACH1

TRACH2


References

  • Verbal communication of ventilator-dependent patients. Crit Care Med 1993; 21:512-517
  • Scintigraphic quantification of aspiration reduction with the Passy-Muir valve. Laryngoscope 1996; 106:231-234