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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4597_Библиотеки_им_академика_М_И_Перельмана.pdf
Tracheostomies
72
Portex Blue Line Uncuffed
Portex Blue Line uncuffed tracheostomy tube.
Photo courtesy of Smiths Medical.
Structure: Cuffed, single-cannula, 90-degree curva-
ture to the shaft
Material: Siliconized polyvinyl chloride
Manufacturer: Smiths Medical
Unique Features: The Blue Line tube is identifi-
able by its blue neck flange, inflation line, and pilot
balloon
Use: For the patient who does not require a cuff and
for whom secretions are not a concern (however, a
separate inner cannula can be used when necessary)
The Portex Blue Line series of tracheostomy tubes are primarily singlecannula tubes; however, they do have a corrugated inner cannula that can be used
when needed (ordered separately). When used, the inner cannula decreases the
diameter of the airway by 2 mm. The Blue Line tracheostomy tube is recognizable by its soft, flexible blue neck flange and shaft. The Blue Line tracheostomy
tubes have a 90% curvature to the shaft.
Portex Blue Line Ultra Uncuffed
Structure: Uncuffed, single-cannula
Material: Siliconized polyvinyl chloride
Manufacturer: Smiths Medical
Unique Features: Presence of a central channel to
accommodate guide wire; larger curvature than standard Blue Line tube
Use: For the patient who does not require a cuff and
for whom secretions are not a concern
Portex Blue Line Ultra uncuffed tracheostomy tube
over guide wire. Photo courtesy of Smiths Medical.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
The Portex Blue Line Ultra series of tracheostomy tubes are very similar to
the standard Portex Blue Line tubes but have a larger curvature. This feature
theoretically allows the cuff to be more centrally placed within the airway. The
inner cannula of the Blue Line Ultra decreases the diameter of the airway by
1 mm, as opposed to 2 mm for the other Portex tubes. One of the most unique
features of the Blue Line Ultra is a central channel through the obturator, which
can accommodate a guide wire for insertion.
Moore
Structure: Uncuffed, single- or dualcannula
Material: Silicone
Manufacturer: Boston Medical Products
Unique Features: Soft and flexible, con-
forms to shape of individual neck and
trachea
Use: When positive-pressure ventilation
is not required and comfort is desired
73
Moore tracheostomy tube (pictured with two inner cannulas
and obturator). Courtesy of Boston Medical Products. All rights
reserved.
The Moore tracheostomy tube is a flexible, single- or dual-cannula cuffless
tube made of silicone. It comes in two sizes (6 and 8), and both have a standard
length of 115 mm. The manufacturer reports that the extra-long length can be
trimmed to fit. The outer cannula comes with a standard inner cannula, a lowprofile inner cannula, and an obturator. The inner cannula can be soaked in
warm soapy water for 10 minutes to loosen any crusts. If necessary, the inside of
the inner cannula can be cleaned with a soft-bristle bottle brush.
Tracheostomies
74
Arcadia Silicone Cuffless
Arcadia Silicone Cuffless tracheostomy tube (with obturator in
place). Arcadia Medical Corporation, www.arcadiamedical.com.
Structure: Uncuffed, single-cannula
Material: Flexible silicone
Manufacturer: Arcadia Medical
Corporation
Unique Features: Soft contoured neck
flange minimizes stomal irritation
Use: When positive-pressure ventilation
is not required and when secretions are
not a concern
The Arcadia Silicone Cuffless tracheostomy tube has a 90-degree angle
to the shaft for better placement within the airway. The neck flange has a 15-mm
swivel connector.
Bivona Sleep Apnea
Bivona Sleep Apnea tracheostomy tube
(with plug). Photo courtesy of Smiths
Medical.
Structure: Uncuffed, single-cannula
Material: Flexible silicone
Manufacturer: Smiths Medical
Unique Features: Low-profile appearance; comes with two plugs
Use: When positive-pressure ventilation is not required and
when secretions are not a concern
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
The Bivona Sleep Apnea tubes are always cuffless and have a low profile.
They are made of flexible silicone. Because of their low-profile nature, they are
not recommended for patients who require ventilatory support or airway access
for suctioning and pulmonary hygiene. Its low-profile design makes it easily
capped and concealed during waking hours. The Bivona Sleep Apnea tracheostomy tube also comes in a version with an inner cannula with a 15-mm connector, which is called an “inhalation set.”
Special Use Tracheostomy Tubes
There are several specialty tracheostomy tubes available for specific needs.
These include talking tracheostomy tubes, extra-long tubes, fenestrated tubes,
double-cuffed tubes, and custom-designed tubes.
Talking Tracheostomy Tubes
A few tracheostomy tubes available are called “talking trachs.” These tracheostomy tubes are typically cuffed tubes with an additional lumen that terminates above the cuff and allows air to reach the vocal cords. When the tube is
in the proper position and the proximal connector is attached to oxygen or an
air-regulated gas source, air flows into the line. The patient or assistant must
occlude the thumb port of this air supply line to direct the gas flow upward
through the vocal cords. Gas flow usually starts at 4–6 liters per minute and
can be adjusted upward until optimal voice quality is attained; however, a maximum of 10–15 liters per minute is recommended.
Another method of phonation with the talking tracheostomy tube is connecting the gas line to a suction source. When the thumb port is occluded,
air is drawn in through the nose and mouth and passes through the vocal
cords from the opposite direction. The product literature for the Portex Blue
Line Trach Talk recommends setting the initial negative pressure on the
suction system to 80 mm Hg and adjusting to voice quality with a maximum
of 180 mm Hg.
This suction port can also be used as a suction line to remove secretions
produced above the cuff, rather than for phonation. By occluding the thumb
port, these secretions are easily removed. The disadvantage, however, is that
the suction line may become clogged with secretions and can be a source of
infection. Because of this, its use as a suction line should be limited to a select
group of patients.
75
Tracheostomies
76
Portex Blue Line Trach Talk
Structure: Cuffed, single-cannula
Material: Siliconized polyvinyl chloride
Manufacturer: Smiths Medical
Unique Features: Air supply line (green) with port that terminates above
the cuff
Use: For the ventilator-dependent patient who desires to speak
Portex Blue Line Trach
Talk tracheostomy
tube. Photo courtesy of
Smiths Medical.
The Portex Blue Line Trach Talk is similar to a Blue Line tracheostomy tube
but has an additional lumen for gas flow. The distal port of the green gas line
terminates just above the cuff of the tube.
TRACOE Twist With Air Supply Line
Structure: Cuffed, dual-cannula
Material: Flexible thermoelastic polyurethane
Manufacturer: Boston Medical Products
Unique Features: Air supply line with port that terminates above the cuff
Use: For the ventilator-dependent patient who desires to speak
The TRACOE Twist cuffed tracheostomy tube with air supply line is another version of the talking tracheostomy tube. It has all of the features of the
TRACOE twist tubes previously disucssed.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
Bivona Fome-Cuf With Talk Attachment
Structure: Cuffed, single-cannula
Material: Silicone
Manufacturer: Smiths Medical
Unique Features: Air supply line with port that
terminates above the cuff
Use: For the ventilator-dependent patient who
desires to speak
77
Bivona Fome-Cuf tracheostomy tube with talk attachment
(pictured with decannulation wedge, cotton twill ties,
ventilator adapter, and large syringe with stopcock).
Photo courtesy of Smiths Medical.
The Bivona Fome-Cuf with talk attachment is the only tube that allows
a patient with a Fome-Cuf tracheostomy to talk. Otherwise, the bulkiness of
this cuff, as well as its default-inflated position, does not allow any air to pass
around the cuff.
Extra-Long Tracheostomy Tubes
There are several circumstances in which an extra-long tracheostomy tube is
beneficial. Extra-long tubes can be useful in cases of tracheomalacia, unusual
anatomy, or morbid obesity. In the case of tracheomalacia, an extra-long tube
will place the cuff in a more distal position within the trachea, which can allow
the damaged area to heal. There are different types of extra-long tracheostomy
tubes, and they all have different features.
Tracheostomies
78
Bivona Hyperflex
Bivona Hyperflex tracheostomy tube with fixed-neck flange.
Note wire-reinforced shaft. Photo courtesy of Smiths
Medical.
Structure: Cuffed, single-cannula, no curva-
ture to the shaft
Material: Flexible silicone; wire reinforced
Manufacturer: Smiths Medical
Unique Features: Adjustable neck flange to
accommodate variable length, shaft has no
predetermined shape and can conform to a
wide variety of anatomical variations, while
wire reinforcement allows it to maintain its
diameter without kinking regardless of its
position
Use: For the patient who requires an extralong tracheostomy tube; ideal for the patient
with unusual anatomy such as an extra-long
or extra-wide neck
The Bivona Hyperflex tracheostomy tube is a single-cannula, extra-long
tracheostomy with a silicone shaft reinforced with wire, allowing it to retain its
shape no matter its position. Because it is armored with wire, it is not compatible with magnetic resonance imaging (MRI). If the patient requires an MRI,
this tube must be changed out.
The Bivona Hyperflex was designed to provide extra length to accommodate
patients with thick bull necks, anatomical airway anomalies, or other conditions
such as tracheomalacia. The neck flange is manufactured with an adjustable
or fixed neck. The adjustable-neck flange is designed as a temporary measure
to accommodate individual needs. It is secured in place with a wrap-and-snap
connection in which a band of silicone wraps around the shaft of the tube and
hooks to itself. Even when locked in place, this adjustable-neck flange can move
when traction is exerted on it, especially in a patient with a large amount of secretions. The manufacturer cautions that it is meant for temporary use until the
proper length tube can be obtained. It should be replaced with a tracheostomy
tube with a fixed-neck flange. The fixed-neck flange of the Hyperflex is flexible
but fused to the shaft of the tube. The adjustable-neck flange model comes in
two varieties of cuff: Aire-Cuf and TTS. The fixed-neck flange model used to be
a custom order; however, it currently comes in standard lengths with three standard cuff varieties: Aire-Cuf, uncuffed, and TTS.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
Arcadia Air Cuff Adjustable-Neck Flange
Structure: Cuffed, single-cannula, no
curvature to the shaft
Material: Flexible silicone; wire
reinforced
Manufacturer: Arcadia Medical
Corporation
Unique Features: Adjustable-neck
flange to accommodate variable
length, shaft has no predetermined
shape and can conform to a wide
variety of anatomical variations,
while wire reinforcement allows it
to maintain its diameter without
kinking regardless of its position
(an access port located above the
cuff can be connected to suction
to prevent aspiration or to direct
Arcadia Air Cuff Adjustable-Neck Flange tracheostomy tube. Note
subglottic suction port in addition to inflation line. Arcadia Medical
Corporation, www.arcadiamedical.com.
airflow above the cuff to allow for
phonation)
Use: Designed to accommodate patients with unusual anatomy, airway
complications, and trauma
79
The Arcadia adjustable-neck flange tracheostomy tube is a single-cannula,
extra-long tube with a silicone shaft reinforced with wire, allowing it to retain its shape no matter its position. Because it is armored with wire, it is not
compatible with MRI. If a patient requires an MRI, this tube must be changed
out. This tube also has a port above the cuff that may be used to remove secretions. In addition to this subglottic suction channel, one of the most unique
features of the Arcadia adjustable-neck flange tracheostomy tube is its locking
mechanism. The shaft passes through a twist-lock mechanism that locks it into
place. When locked, this mechanism will not move, unlike the Bivona Hyperflex
adjustable-neck flange, which may move especially when exposed to secretions.
The manufacturer, however, cautions that the Arcadia adjustable-neck flange
tube should also be replaced with a fixed-neck flange tube.
Tracheostomies
80
Shiley TracheoSoft XLT
Structure: Cuffed, dual-cannula
Material: Semisoft polyvinyl chloride
Manufacturer: Covidien
Unique Features: Extra-long, dual-
cannula tracheostomy tube comes in
either extra distal or extra proximal
length
Use: For the patient with a thick or
extra-long neck and for whom thick
secretions are a concern
Shiley TracheoSoft XLT tracheostomy tube. Note extended
horizontal length (Covidien).
The Shiley TracheoSoft XLT tracheostomy tube is an extra-long tube constructed of semisoft polyvinyl chloride. It has a disposable inner cannula and
comes in an extra distal as well as extra horizontal length. It was taken off the
market in 2004 because of design issues but has since been redesigned and reintroduced. Its most valuable feature is that it is currently the only extra-length
tracheostomy tube with an inner cannula. Because of its inner cannula and
extra length, it is ideal for the patient with an extra-large or extra-long neck
who also has a large amount of secretions.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
TRACOE Vario
Structure: Cuffed or uncuffed; singlecannula
Material: Spiral reinforced polyvinyl
chloride or clear polyvinyl chloride
Manufacturer: Boston Medical
Products
Unique Features: Extra length and
adjustable wings on the neck flange;
models include cuffed, cuffless, wirereinforced, and one model with a
suction port above the cuff
Use: For the patient with unique
anatomical needs
81
TRACOE Vario tracheostomy tube. Photo courtesy of Boston
Medical Products. All rights reserved.
The TRACOE Vario tracheostomy tubes are extra-long, single-cannula tubes
with adjustable-neck flanges. Two of the TRACOE Vario models are wire reinforced (models 450 and 455), and an MRI is contraindicated with these tubes
in place. The TRACOE Vario tubes have a wide angle to the shaft and come in
cuffed (models 450, 460, and 470) and cuffless (models 455 and 465) versions.
In addition, one of the models also has a suction attachment port above the cuff
for the patient with copious subglottic secretions (model 470). The wings of the
neck flange can be placed in different positions.