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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4597_Библиотеки_им_академика_М_И_Перельмана.pdf
Tracheostomies
82
TRACOE Comfort Extra Long
TRACOE Comfort extra-long tracheostomy tube. Photo
courtesy of Boston Medical Products. All rights reserved.
Structure: Uncuffed, single- or dual-cannula,
fenestrated or nonfenestrated
Material: Flexible polyvinyl chloride
Manufacturer: Boston Medical Products
Unique Features: Clear, flexible material; extra
length; low profile
Use: When positive-pressure ventilation is not
required and secretions are not a concern
The TRACOE Comfort line of extra-length tracheostomy tubes is made of
a very soft, flexible, clear, and lightweight medical polymer. They are always
cuffless and come with or without an inner cannula. Most of the models are low
profile in nature and do not have a 15-mm adapter; however, one of the models
(205) comes with a 15-mm adapter on the inner cannula so positive pressure
can be used. Model 204 comes with a swivel speaking valve. Model 203 comes with
a silver speaking valve and can also be ordered with an oxygen supply port.
The manufacturer recommends that paraffin oil be used with the dual-cannula
tracheostomy tubes at least every other day to lubricate the inner cannula and
ensure it is easy to insert and remove.
Portex Blue Line Extra Horizontal Length
Structure: Cuffed, single-cannula
Material: Siliconized polyvinyl chloride
Manufacturer: Smiths Medical
Unique Features: Extra horizontal length
Use: For the patient with a thick neck
The Portex Blue Line Extra Horizontal Length tracheostomy tube is made of
siliconized polyvinyl chloride. The proximal length is elongated to accommodate
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
large or thick necks. This tracheostomy tube is no longer available (personal
communication, Mark Larue, Portex sales representative, November 2008).
Tracheostomy Tubes With Additional Suction Channel
A few tracheostomy tubes on the market have specifically designed suction
channels. The accumulation of secretions above the cuff has been implicated
in the development of ventilator-associated pneumonia. The Portex Blue Line
Ultra Suctionaid tube has been developed to meet that need. In addition, the
TRACOE Twist and Vario tubes both have specifically designed suction ports.
Any talking tracheostomy tubes or those with an additional air supply line have
also been used successfully for intermittent or continuous suctioning above the
cuff. The major problem with a suction channel of any kind is that it tends to get
clogged with secretions. However, simply flushing the line with water or saline
(with the cuff inflated) usually remedies the problem.
83
Portex Blue Line Ultra Suctionaid tracheostomy
tube. Note subglottic suction port in addition to
inflation line. Photo courtesy of Smiths Medical.
Metal Tracheostomy Tubes
Metal tracheostomy tubes are always uncuffed. There are several types of metal
tracheostomy tubes, but the Jackson tracheostomy is the oldest and probably
best known. Metal tracheostomy tubes can be constructed of stainless steel or
silver. They are heavier than plastic tubes and can reflect ambient temperature.
The primary differences among these metal tubes are the design of the neck
flange, the length, and the angle of tube curvature. A metal tracheostomy tube
can last a lifetime, but it does require regular cleaning, as do tubes made of
plastic and other softer materials. For this reason, a metal tracheostomy tube
may be preferred in patients who pay out of pocket or those who will be returning to a country where plastic tubes are difficult to obtain.
Tracheostomies
84
centers, they are rarely seen. Metal tracheostomy tubes are sometimes preferred when it is known the tube will be permanent, such as in head or neck
cancer or trauma.
this reason, they often come in a variety of lengths. Many metal tubes are completely interchangeable within a size and style. One of the biggest advantages of
metal tracheostomy tubes is that the walls of the tube are thinner. A unique advantage of silver tubes is that they are reported to have bactericidal properties.
daily. Chemical cleaners such as hydrogen peroxide, enzyme cleaners, or sodium
hydroxide should not be used with metal tubes because they can cause damage.
More detailed instructions for cleaning metal tracheostomy tubes can be found
in chapter 7.
Jackson
Some medical centers frequently use metal tracheostomy tubes; in other
Metal tracheostomy tubes cannot be customized as easily as plastic tubes. For
One manufacturer recommends that metal tracheostomy tubes be cleaned
Jackson tracheostomy tube. Note low-profile inner
cannula. Pilling product image provided courtesy of
Teleflex Medical.
Structure: Uncuffed, dual-cannula
Material: Stainless steel or sterling silver
Manufacturers: Pilling (Teleflex Medical), Premier Medical Products
Unique Features: Parts are completely adaptable within a size and style
Use: For the patient who prefers a metal tracheostomy
Jackson Improved tracheostomy tube with 15-mm
adapter. Premier Medical Products.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
The Jackson tracheostomy tube was the original metal tube. The original
Jackson tracheostomy tubes came in stainless steel, but there is also a model
in sterling silver. This sterling silver model has a rotating lock to hold the lowprofile inner cannula in place, and this swivel-locking ring is also found on
the Jackson Improved models. The original Jackson tracheostomy tubes have a
swivel lock to hold the inner cannula in place and as such are low profile, but
they can be fitted with 15-mm adapters for use with positive-pressure ventilation. There are currently two manufacturers of the Jackson tracheostomy
tube: Pilling (Teleflex Medical) and Premier Medical Products. At Premier, the
15-mm adapter is permanently attached to the Improved pattern tube. The neck
flange may have different shapes depending on the size of the tube. With Premier tubes, sizes 00 to 8 have a small rectangular shape, while sizes 9 and 10
have a larger oval neck flange (personal communication, Toni Banet, Premier
Medical Products, May 2009).
Holinger
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Structure: Uncuffed, dual-cannula
Material: Sterling silver
Manufacturer: Pilling
Unique Features: Tube is attached to the neck flange at a 65-degree, acute downward angle;
sterling silver has bactericidal effect
Use: For patients who prefer a metal tracheostomy tube
Holinger tracheostomy tubes are sterling silver with a rectangular neck
flange. Sizes vary from 000 to 8. The Holinger tube is attached to the neck flange
at an acute downward angle of 65 degrees, rather than the usual alignment of
90 degrees. Holinger tracheostomy tubes are low-profile tubes, with an inner
cannula but without a 15-mm connector.
Tracheostomies
86
Tucker
Structure: Uncuffed, dual-cannula
Material: Sterling silver
Manufacturer: Pilling
Unique Features: Valved inner cannula allows speech
without digital occlusion; sterling silver has bactericidal effect
Use: For the patient who prefers a metal
tracheostomy tube
Tucker tracheostomy tubes.
Tucker tracheostomy tubes are made of sterling silver and may or may
not have a Tucker valve along the shaft of the inner cannula. The Tucker valve
bulges outward during inspiration, allowing the patient to speak without finger
occlusion of the tube. This internal valve is quite different than other types of
speaking valves, which are connected to the outside of the tube. The Tucker
valve is for use with sterling silver tubes only. See chapter 6 for further discussion of phonation.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
Mayo Clinic
Structure: Uncuffed, dual-cannula
Material: Stainless steel
Manufacturer: Pilling
Unique Features: Holinger-style neck flange on Jack-
son stainless steel shaft
Use: For the patient who prefers a metal
tracheostomy tube
Mayo Clinic tracheostomy tube. Pilling product
image provided courtesy of Teleflex Medical.
The Mayo Clinic tube is a metal tracheostomy tube with a Holinger-style
neck flange (rectangular) on a Jackson stainless steel shaft.
87
Martin
Structure: Uncuffed, dual-cannula
Material: Sterling silver
Manufacturer: Pilling
Unique Features: Additional inner cannula with proximal extension of 2.5 cm
Use: For the patient who prefers a metal tracheostomy tube; extended inner cannula projects
out of bulky dressings
The Martin tracheostomy tube is sterling silver and has a low-profile inner
cannula as well as an additional inner cannula with a 2.5-cm proximal extension that can project beyond bulky dressings. It has a standard Jackson curve
and so is interchangeable with Jackson tracheostomy tubes. The Martin tracheostomy tube is no longer manufactured (Patti Pandya, personal communication, Teleflex Medical, November 4, 2009).
Tracheostomies
88
Luer
Luer tracheostomy tube. Pilling product
image provided courtesy of Teleflex
Medical.
Structure: Uncuffed, dual-cannula
Material: Sterling silver
Manufacturer: Pilling
Unique Features: Shorter and more acute curve than Jackson
tracheostomy tube
Use: For the patient who prefers a metal tracheostomy tube
The Luer tracheostomy tube is made of sterling silver and is shorter in
length than the comparable Jackson tube. It has a more acute curve than the
Jackson tracheostomy tubes, but it has the original Jackson-style neck flange.
These are low-profile tubes without 15-mm connectors.
Laryngectomy Tubes
Laryngectomy tubes are always cuffless because laryngectomy patients are
neck breathers. The laryngectomy tube is typically shorter than the comparable
tracheostomy tube and the angle of curvature is narrower. It can have either a
single outer cannula or a dual cannula. Like tracheostomy tubes, laryngectomy
tubes can be rigid or flexible. Because laryngectomy is a permanent stoma, the
tube itself is often not required beyond a few months after initial placement.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
Shiley LGT
Structure: Uncuffed, dual-cannula, short, narrow curvature
Material: Rigid polyvinyl chloride
Manufacturer: Covidien
Unique Features: Shorter length and narrower curvature
than standard tracheostomy tube
Use: For the laryngectomy patient in whom secretions are
a concern
Shiley LGT laryngectomy tube (without inner
cannula) (Covidien).
89
The Shiley LGT tracheostomy tube is a rigid tube made of polyvinyl chloride. It has an inner cannula that nests within the outer cannula and, like the
Shiley CFS and LPC, is attached by means of a twist lock. It also comes with a
low-profile, cosmetic inner cannula.
Portex DIC Laryngectomy
Structure: Uncuffed, single-cannula, short, narrow curvature
Material: Silicone
Manufacturer: Smiths Medical
Unique Features: Shorter length and narrower curvature than
standard tracheostomy tube
Use: For the laryngectomy patient in whom secretions may be a
concern
Portex DIC laryngectomy tube. Photo
courtesy of Smiths Medical.
Tracheostomies
90
The Portex DIC laryngectomy tube is a flexible silicone tube with an inner
cannula.
TRACOE Twist Laryngectomy
Structure: Uncuffed, dual-cannula, short, narrow
curvature
Material: Flexible thermoelastic polyurethane
Manufacturer: Boston Medical Products
Unique Features: Shorter length and narrower curva-
ture than standard tracheostomy tube
Use: For the laryngectomy patient in whom secretions may be a concern
TRACOE Twist laryngectomy tube. Photo courtesy
of Boston Medical Products. All rights reserved.
The TRACOE Twist laryngectomy tube is made of medical-grade polyurethane, similar to the TRACOE Twist tracheostomy tubes. It has a standard inner
cannula with a 15-mm connector and a low-profile inner cannula.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
TRACOE Comfort Laryngectomy
Structure: Uncuffed, dual-cannula, short, narrow curvature
Material: Flexible polyvinyl chloride
Manufacturer: Boston Medical Products
Unique Features: Clear, flexible material; comes with one or
two inner cannulas
Use: To maintain patency of the stoma following
laryngectomy
TRACOE Comfort laryngectomy tube.
Photo courtesy of Boston Medical Products.
All rights reserved.
91
The TRACOE Comfort laryngectomy tube is clear and flexible with an inner
cannula that can be removed for cleaning.