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Tracheostomy tube types and partsTTracheostomy tube types and partsTracheostomy tube types and partsEnglishRespiratoryChild (0-12 years);Teen (13-18 years)Lungs;TracheaRespiratory systemNon-drug treatmentCaregivers Adult (19+) Hospital healthcare providersNA2017-06-29T04:00:00ZReshma Amin, MD, FRCPC, MSc;Faiza Syed, BHSc, RRT;Tuyen Tran, RRT000Flat ContentHealth A-Z

 

 

Tracheostomy tube types and parts2916.00000000000Tracheostomy tube types and partsTracheostomy tube types and partsTEnglishRespiratoryChild (0-12 years);Teen (13-18 years)Lungs;TracheaRespiratory systemNon-drug treatmentCaregivers Adult (19+) Hospital healthcare providersNA2017-06-29T04:00:00ZReshma Amin, MD, FRCPC, MSc;Faiza Syed, BHSc, RRT;Tuyen Tran, RRT000Flat ContentHealth A-Z<figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_different_sizes_EN.jpg" alt="Tracheostomy tubes of different sizes." /></figure> <p>A tracheostomy tube is inserted into the trachea through the stoma in the neck to help your child breathe.</p><p>The tube itself is curved and hollow and can be made of polyvinyl chloride (PVC), polyurethane, silicone or a combination. PVC is the most commonly used material. Although less common, tracheostomy tubes can also be made of stainless steel or silver.</p><p>Many different adjuncts (attachments) can go on the end of a tracheostomy tube, such as:</p><ul><li>a tracheostomy cap</li><li>a <a href="/Article?contentid=2922&language=English">heat and moisture exchanger (HME)</a></li><li>a <a href="/Article?contentid=2969&language=English">speaking valve</a></li><li>a <a href="/Article?contentid=2960&language=English">tracheostomy mask</a></li><li>a <a href="/Article?contentid=2924&language=English">heated high flow humidifier</a></li><li>a <a href="/Article?contentid=2937&language=English">ventilator​</a>.</li></ul> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_red_cap_EN.jpg" alt="A tracheostomy cap covering the tracheostomy cannula" /> <figcaption class="asset-image-caption">A tracheostomy cap fits over the opening of the tracheostomy tube.</figcaption> </figure> <p>A tracheostomy cap completely covers the end of a tracheostomy tube and prevents air from entering or leaving. It can be used during the day for children that need ventilation at night. It is often used when a plan is in place to remove the tracheostomy tube.</p><p>It can be dangerous for your child to use a tracheostomy tube cap if it is not deemed safe for use by your healthcare provider. If your child is allowed to use a tracheostomy tube cap, your healthcare team will give you clear recommendations before your child is discharged home.</p><h2>Types of tracheostomy tube</h2><p>Tracheostomy tubes can have two or three parts. Two-part tracheostomy tubes are most commonly used in children.</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Two-part tracheostomy tube</span> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_2_part_tubes_EN.jpg" alt="The outer cannula (part 1) and the obturator (part 2) of a tracheostomy tube." /><figcaption class="asset-image-caption">The obturator is a removable part of a two-part tracheostomy tube, and is used only when inserting the tube.</figcaption></figure> <h3>Two-part tracheostomy tube</h3><p>A two-part tracheostomy tube consists of an:</p><ul><li>outer cannula with a flange (neck plate)</li><li>obturator.</li></ul></div></div><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Three-part tracheostomy tube</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_3piece_tracheostomy_tube_EN_72original.jpg" alt="The outer cannula, inner cannula and obturator" /><figcaption class="asset-image-caption">The inner cannula locks inside the outer cannula and can be replaced and cleaned more often. The obturator is used only when inserting the tracheostomy tube.</figcaption> </figure> <h3>Three-part tracheostomy tube</h3><p>A three-part tracheostomy tube consists of an:</p><ul><li>obturator</li><li>outer cannula with a flange (neck plate)</li><li>inner cannula.</li></ul><p>The obturator fits inside the tracheostomy tube and helps guide the tracheostomy tube through the stoma during insertion.</p><p>The inner cannula sits inside the outer cannula and can be removed and re-inserted without having to do a complete tracheostomy tube change. </p></div></div><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Tracheostomy tube identifiers </span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_Numbers_tracheostomy_tube_EN_72original.jpg" alt="Brand, size, and type are indicated on the obturator and neck plate of a tracheostomy tube." /> <figcaption class="asset-image-caption">The text on tracheostomy tubes identifies the brand, size and type of tube.</figcaption></figure> <h3>Identifiers on tracheostomy tubes</h3><p>You will see some letters and numbers on your child's tracheostomy tube. These will help you make sure you are using the right tube for your child.</p><ul><li>On the right flange (left side If you are looking at your child), is the brand of the tube, the size and the type.</li><li>On the obturator, in the middle, is the size. The number is the diameter or thickness of the tube. It should be the same as the number on the right flange. The letters (NEO or PED) indicate the length of the tube.</li><li>On the left flange (right side if you are looking at your child), is the inner diameter (ID)​ of the tube and, underneath, the outer diameter (OD). Both of these measurements are in millimetres.</li></ul></div></div></div><p>A tracheostomy tube can also be cuffed, uncuffed, fenestrated or have an extended flange.</p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Bivona Aire-Cuf tracheostomy tube</span> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_cuffed_tubes_EN.jpg" alt="A cuffed tracheostomy tube showing the inflated cuff, inflation line, port, valve and syringe with air" /> <figcaption class="asset-image-caption">Cuffed tubes can be air- or water-filled. The tube is filled through the cuff port and inflation line.</figcaption></figure> <h3>Cuffed tracheostomy tube</h3><p>A cuffed tracheostomy tube has a balloon on the outside of the tube. When the balloon is inflated, it gently seals the airway to prevent air or fluid from passing around the cuff. One result of this is that air cannot reach your child’s voice box, meaning that your child cannot speak when the balloon is inflated.</p><p>There are three types of cuffed tracheostomy tubes:</p><ul><li>high volume/low pressure</li><li>low volume/high pressure</li><li>foam cuff.</li></ul><p>Your child's healthcare provider will tell you which cuffed tube, if any, your child should use. It is important to not substitute one for another. Always follow the manufacturer’s instructions to make sure you are filling the tracheostomy tube cuff with the correct substance (water or air).</p></div></div><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Shiley air- and water-cuffed tubes</span> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_air_water_tubes_EN.jpg" alt="A water-fill and air-fill port on Shiley cuffed tracheostomy tubes" /><figcaption class="asset-image-caption">Cuffed tracheostomy tubes can be filled with air or water.</figcaption></figure> <h4>​High volume/low pressure cuff</h4><p>This type of cuff is larger than others and, as a result, has a larger area that “touches” the trachea. This allows for a better seal when the cuff is inflated. The cuff can be filled with water or air as recommended by the tracheostomy tube manufacturer.</p><p>The downside of this type of cuff is that, even if it is deflated, the “shell of the cuff” will still occupy a bigger space in the trachea than the tube shaft itself.</p><h4>Low volume/high pressure cuff</h4><p>This cuff is smaller and forms around the tracheostomy tube shaft. It can also be filled with water or air as recommended by the tracheostomy tube manufacturer. When the cuff is deflated, it acts like a cuffless tube.</p><p>The downside of this type of cuffed tube is that it puts greater pressure against the tracheal wall when it is inflated. This may damage the tissue in your child's trachea over time. As a result, this type of tube is not suitable for patients with a long-term need for a cuffed tracheostomy tube.</p><p>If your child uses a tracheostomy tube with a non-foam cuff, your healthcare team will provide clear instructions about:</p><ul><li>when to inflate and deflate the cuff</li><li>whether to use water or air to inflate the cuff</li><li>how many millilitres of air or water to use when inflating the cuff.</li></ul></div></div><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Foam-cuffed tubes</span> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_foam_cuff_EN.jpg" alt="A Bivona Fome cuff showing the air-inflated foam balloon at the end" /><figcaption class="asset-image-caption"> A Bivona Fome cuff is inflated with air.</figcaption></figure> <h4>Foam cuff</h4><p>A foam cuff is the least common type of cufffed trachesotomy tube. The foam cuff provides a continuous seal to the airway.</p><p>Sometimes, the tracheostomy tube cuff is deflated to allow your child to speak. If your child uses a cuffed tracheostomy tube, you will work with your healthcare provider to develop a care plan for when the cuff should be inflated or deflated.<br></p></div></div></div><h3>Uncuffed tracheostomy tube</h3><p>When a tracheostomy tube is uncuffed, some air may be able to pass up and around the tracheostomy tube, the vocal cords, the mouth and nose.</p><p>Some children can produce sounds around their tracheostomy, but others cannot. </p><div class="akh-series"><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Tracheostomy tube showing fenestration (holes)</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_trach_fenestrated_EN.jpg" alt="A tracheostomy with fenestrations (holes) along the outer cannula" /> <figcaption class="asset-image-caption">Fenestrations in the outer cannula allow air to flow up to the vocal cords.</figcaption> </figure> <h3>Fenestrated tracheostomy tube</h3><p>A fenestrated tracheostomy tube is similar to other tracheostomy tubes, but it has holes in the outer cannula to allow air to pass from your child’s lungs up through their vocal cords and out through their mouth and nose. It can also be used as a step on the way to removing your child’s tracheostomy tube.</p><p>The fenestrated tracheostomy tube lets your child:</p><ul><li>speak using their vocal cords because i​t allows air to pass through the larynx and between the vocal folds</li><li>cough secretions (mucus) out through their mouth.​</li></ul></div></div><div class="row"><div class="col-md-12"> <figure> <span class="asset-image-title">Tracheostomy ties </span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_trach_ties_EN.jpg" alt="A tracheostomy tube with ties attached to holes in the neck plate" /> <figcaption class="asset-image-caption">A tracheostomy tube is held in place with ties that wrap around the neck.</figcaption></figure> <h2>How is the tracheostomy tube secured so it does not fall out?</h2><p>Your child's tracheostomy tube is secured with tracheostomy ties. These ties can be made of cotton, foam or nylon padding or, most commonly, Velcro. They attach to either side of the neck plate and go around the neck. Some ties also offer a moisture wick lining to keep skin dry and reduce breakdown.</p></div></div></div> <a class="btn btn-primary" href="https://www.aboutkidshealth.ca/trachvent">Return to trach-vent learning hub</a> <br>Tracheostomy tube types and partsTruehttps://www.aboutkidshealth.ca/Article?contentid=2917&language=Englishhttps://www.aboutkidshealth.ca/Article?contentid=2915&language=English

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