Tracheostomy Tubes

A tracheostomy tube may be metallic or nonmetallic

• Metallic Tracheostomy Tube

Metallic tubes are formed from the alloy of silver, copper and phosphorus

Has an inner and an outer tube.The inner tube is longer than the outer one so that secretions and crusts formed in it can be removed and the tube reinserted after cleaning without difficulty. However, they do not have a cuff and cannot produce an airtight seal.

• Nonmetallic Tracheostomy Tube

Can be of cuffed or noncuffed variety, e.g. rubber and PVC tubes. 

Cuffed Tracheostomy Tubes

• A cuff is a balloon-like device around the distal end of the tracheostomy tube. Most cuffed tubes now available have low pressure cuffs with a high volume. This significantly reduces the possibility of pressure necrosis and potential stenosis formation. Pediatric tubes do not have a cufr. Cuffed tubes are used in situation where positive pressure ventilation is required, or when the airway is at risk from aspiration. (In unconscious patient or when patient is on respiration).

The cuff should be deflated every 2 hours for 5 mins to present pressure damage to the trachea.

Uncuffed Tracheostomy Tubes

This tube does not have a cuff that can be inflated inside the trachea.

It is suitable for a patient who has returned to the ward from a prolonged stay in intensive care and requires physiotherapy and suction via trachea.

This type of tube is not suitable for patients who are unable to swallow due to incompetent laryngeal reflexes, and aspiration of oral or gastric con­tents is likely to occur.

An uncuffed tube is advantageous in that it allows the patient to breathe around it in the event of the tube becoming blocked. Patients can also speak with an uncuffed tube.

Ans. D: Ideally should be changed every 3rd day

Inner cannula should be removed and cleaned as and when indicated for the first 3 days. Outer tube, unless blocked or displaced, should not be removed for 3-4 days to allow a track to be formed when tube placement will be easy.