Presentation on theme: "What Kind of Tube is This?!"— Presentation transcript:
1 What Kind of Tube is This?! Linda M. Folk, RRT, LRTUniversity of Michigan Health CentersCritical Care Support Services
2 ObjectivesBe able to identify the various tubes on the market and how to use them.Be able pick a trach tube or accessory that would allow your ventilated patient to speak.Be able to explain the use of a T-tube.
8 Standard Shiley Tracheostomy Tube – Cuffed with Disposable Inner Cannula
9 Metal Tracheostomy Tube - Uncuffed Outer cannulaInner cannulaObturatorMetal tracheostomy tubes are for patients that need to maintain a patent airway and don’t need a cuffed tube. The tube is non-disposable. Patients are usually given two, so they can clean one and use one. They have a low profile on the neck and the patient can occlude the opening with their finger and talk. Special adapters are needed to connect a manual resuscitation bag to these tracheostomy tubes.
10 Proximal Extended Tracheostomy Tube Extension is from curve to flangecuffInner cannulaobturatorThis tube is extended from the curve to the flange (proximal) to accommodate patients with thick necks. The inner cannula is disposable.
11 Proximal and Distal Extended Tracheostomy Tubes Proximal extended trach tubeDistal extended trach tubeDistal extensionProximal extensionProximal extended tube – intended for patients with thick necksDistal extended tube – intended for patients that need a longer tube to extend past damaged area of trachea or obstruction
12 Cuffed Fenestrated Tracheostomy Tube Pilot ballooncufffenestrationplugInner cannulaobturatorFenestrated tracheostomy tubes allow the patient to talk while still maintaining a patent airway. The cuff must be deflated completely. The inner cannula is removed and replaced with a plug. The patient breathes through the nose and mouth. Air moves through the fenestration and around the tube. Upon exhalation, the air moves back up through the fenestration and around the tube, through the vocal cords and the patient can speak. This picture shows a cuffed tube for the patient that is still requiring mechanical ventilation for periods of time. The plug is removed, the inner cannula replaced and the cuff inflated when returning the patient to the ventilator.
15 Bivona Fome-Cuff Tracheostomy Tube Foam cuffPilot balloonobturatorThis Bivona tracheostomy tube utilizes a foam cuff. The pilot balloon is open to atmosphere and the cuff will fill automatically. Minimal pressure is then exerted on the tracheal wall. When used with patients on mechanical ventilation, the pilot balloon may be connected to a port, inline with the ventilator that will inflate the cuff more during inspiration and then release the pressure during exhalation. This helps the cuff seal during inspiration, but still maintain minimal pressure during exhalation. If not used in this manner, the red pilot balloon should not be capped.
16 Bivona TTS tube (tight-to-shaft) When the cuff is deflated, it lies flat against the tube. This facilitates speaking and swallowing. The cuff is made of material that must be filled with sterile water. Air will diffuse out. Most beneficial for patients that only require nocturnal ventilation with minimal settings.
17 Bivona TTS (Tight-to-Shaft) Tracheostomy Tube with Adjustable Flange cuffClose up of adjustable flangeFlange-adjustablePilot balloonThis tracheostomy tube allows more length than a standard tracheostomy tube, if needed for thick necks or to bypass an area in the trachea that is obstructing, or tracheal mylasia. It has an adjustable flange that allows for adjustment in length if needed. It is very flexible and conforms to the trachea. Close monitoring of the flange should be done, by monitoring the number the flange is locked on. Also, there is no inner cannula. Close monitoring of the patency of the tube, by passing a suction catheter at least twice a shift, is necessary. The patient should always have humidified air or oxygen as well to minimize the chance of plugging of the tube. This tube is not meant to be permanent and should be replaced with a custom tube if needed.
19 Portex double cuff tube This tube is used for patients that may have tracheal stenosis, malasia or to minimize risk of injury by inflating cuffs on a rotating basis.
20 Passy Muir Valve One-way valve This valve is placed on a patient’s tracheostomy tube, with cuff deflated, and allows the patient to speak. The patient is able to breath air through the one-way valve (and some from nose and mouth) and then when they exhale, the valve closes and all of the air moves through their vocal cords. This is easier for the patient than plugging the tube. A couple of safety notes: 1) the cuff must be deflated before placing the valve on the patient’s tube; 2) if the patient is having a lot of difficulty breathing (particularly exhaling) and coughing, the tracheostomy tube may be too large and need to be downsized (i.e, from a #8 to a #6); 3) the patient should not be left alone when first trying this valve until the patient shows they are able to tolerate it well and the patient knows how to remove it if having difficulty breathing. If on oxygen, have a trach mask and nasal cannula available as patient may do better with one or the other.
21 Correct Use of the Passy Muir Valve INCORRECTCORRECTCuff inflatedCuff deflatedNO! NO! NO!Never place the Passy Muir Valve on with the cuff inflated.YES! YES! YES!Cuff is always deflated when the Passy Muir Valve is on.
22 Portex Trach-Talk Tracheostomy Tube The Portex Trach-Talk Tracheostomy tube is designed to allow patients that need the cuff inflated (usually patients on mechanical ventilation) to speak. The blue air line has an opening just above the cuff. The line is connected to an air flowmeter, set at 6-8 lpm. When the finger port is occluded, air exits the port above the cuff and flows up through the vocal cords so the patient can talk. The port must be cleared of secretions frequently so it doesn’t become occluded.
28 ConclusionRespiratory Care Practitioners should play a big role in the monitoring of patients with tracheostomies in the general care setting.Become familiar with the various tracheostomy tubes on the market.