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Tracheostomies
52
Color-Coding Guide for Portex DIC Tracheostomies
3.1
Color of 15-mm Connector
Orange 6
Green 7
White 8
Blue 9
Yellow 10
Portex also makes two dual-cannula cuffed tracheostomy tubes. Made of
polyethylene, the Portex DIC cuffed tracheostomy tube provides a rigid structure to the tube. The 15-mm adapter of the Portex DIC is color coded based on
size. Table 3.1 shows the colors related to size.
The neck flange of the Portex tracheostomy tube is soft and pliable and may
offer more comfort than a rigid neck flange. The inner cannula of the Portex
DIC is removed by lifting up on the ring and pulling it out or pushing it in until it
snaps in place. In contrast to the Shiley LPC or DCT, patients with a Portex DIC
or Portex Flex DIC tracheostomy can be ventilated with or without the inner
cannula in place.
Portex Flex DIC
Size (Inner Diameter)
Portex Flex DIC cuffed tracheostomy tube. Photo courtesy of Smiths
Medical.
Structure: Cuffed, dual-cannula,
arched curve
Material: Flexible polyvinyl chloride
with silicone coating
Manufacturer: Smiths Medical
Unique Features: Color-coded inner
cannula to identify size
Use: Patients who require a cuffed
tube for positive-pressure ventilation, airway protection, or when
secretions are a concern
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
The Portex Flex DIC cuffed tracheostomy tube is made of a softer thermosensitive polyvinyl chloride with a silicone coating. Because of the difference in
material, the outer diameters are different than the standard Portex DIC; however, the color-coding system for the inner cannula is the same. The Portex DIC
and Flex DIC tubes have an arched curve to the shaft, similar to the Shiley LPC
and DIC. The Portex DIC and Flex DIC both have a barrel-shaped cuff.
TRACOE Twist Series
Structure: Cuffed, dual-cannula
Material: Flexible thermoelastic
polyurethane
Manufacturer: Boston Medical Products
Unique Features: Neck flange that rotates
on two planes
Use: Patients who require a cuffed tube for
positive-pressure ventilation, airway protection, or when secretions are a concern
53
TRACOE Twist cuffed tracheostomy tube. Photo courtesy of
Boston Medical Products. All rights reserved.
The TRACOE Twist series of tracheostomy tubes is similar to the Shiley
LPC in that it has a cuff and consists of an inner cannula nested into an outer
cannula with a twist-lock mechanism. However, it is made of a more flexible
material—polyurethane—that becomes more pliable at body temperature. Another difference is that the neck flange moves on two planes, both vertically and
horizontally, accommodating more patient movement.
Tracheostomies
54
The TRACOE Twist line of tubes comes in a wide variety of features. There
are dual-cannula cuffed tubes, dual-cannula cuffless tubes, cuffed tubes with
suction lines, cuffless tubes with suction lines, fenestrated cuffed tubes, fenestrated cuffless tubes, cuffed tubes with oxygen supply lines, and cuffed tubes
with air supply lines. All these tracheostomy tubes have the same dimensions
of inner diameter, outer diameter, and length.
Portex Lo-Profile Cuffed
Structure: Cuffed, dual-cannula
Material: Polyvinyl chloride
Manufacturer: Smiths Medical
Unique Features: Clear neck flange and 15-mm connector; low-profile, semireusable inner
cannula
Use: For the patient who requires a cuffed tube but desires a less conspicuous appearance
The Portex Lo-Profile series of tracheostomy tubes are designed “for the
active patient.” It has a clear neck flange and a clear, low-profile inner cannula.
It is also packaged with a standard inner cannula with a clear, 15-mm connector. It comes in cuffed and cuffless versions. The inner cannula is semireusable,
meaning it can be cleaned and reused up to 21 times. As opposed to the Portex
Blue Line series, DIC series, and Flex DIC series of tracheostomy tubes, the inflation line and pilot balloon of the Portex Lo-Profile tubes are clear.
Dual-Cannula Cuffless Tracheostomy Tubes
Cuffless dual-cannula tracheostomy tubes should be used only in those patients who can protect their airway and are best used for those who also have
thick or large quantities of secretions. In this circumstance, the inner cannula
can be removed and cleaned or replaced to prevent obstruction of the tube. This
type of tube is ideally suited to the patient who can protect his airway, who does
not require positive-pressure ventilation, and who wishes to speak; however,
secretions may be an issue.
The Portex versions of dual-cannula cuffless tracheostomy tubes are the
Portex DIC uncuffed and the Portex Flex DIC uncuffed tubes. Both tubes have
color-coded inner cannulas.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
Portex DIC Uncuffed
Structure: Dual-cannula, cuffless, curved
arch to the shaft
Material: Rigid polyvinyl chloride
Manufacturer: Smiths Medical
Unique Features: Disposable and color-
coded inner cannula
Use: For the patient who can protect his
airway, yet secretions may be a concern;
when capped, phonation can occur
55
Portex DIC uncuffed tracheostomy tube. Photo courtesy of
Smiths Medical.
The Portex DIC uncuffed tracheostomy tube is identical to the Portex DIC
except that it is cuffless. The inner cannula is color coded based on size (see
Table 3.1). It includes a locking ring that secures the inner cannula to the outer
cannula. The disposable inner cannula is removed and replaced on a regular
basis—usually every 8 hours—to prevent the accumulation of secretions. The
disposable inner cannula is often preferred by nurses because it saves cleaning
time (see chapter 7).
Tracheostomies
56
Portex Flex DIC Uncuffed
Structure: Dual-cannula, cuffless, arched
curve to the shaft
Material: Flexible thermosensitive polyvinyl chloride with silicone coating
Manufacturer: Smiths Medical
Unique Features: Color-coded inner can-
nula to identify size
Use: For the patient who can protect his
airway, yet secretions may be a concern;
when capped, phonation can occur
Portex Flex DIC uncuffed tracheostomy tube. Photo courtesy
of Smiths Medical.
The materials for these uncuffed tubes are the same as the cuffed versions.
The Portex Flex DIC tracheostomy tube is made of a softer thermosensitive
polyvinyl chloride with a silicone coating, and the Portex DIC is made of a rigid
polyvinyl chloride. The color-coding system for the inner cannula is also the
same (see Table 3.1). The Portex DIC and Portex Flex DIC tracheostomy tubes
have an arched curve to the shaft, similar to the Shiley LPC and DCT.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
Shiley CFS
Structure: Dual-cannula, cuffless, arched curve to
the shaft
Material: Rigid polyvinyl chloride
Manufacturer: Covidien
Unique Features: Cosmetic inner cannula and capped
inner cannula are included in kit
Use: For the patient who can protect his airway, yet
secretions may be a concern; when capped, phonation can occur
57
Shiley CFS tracheostomy tube (without inner
cannula) (Covidien).
The Shiley CFS is identical to the LPC except that it is cuffless. It is constructed of rigid polyvinyl chloride. The CFS is packaged with a standard inner
cannula, a capped inner cannula, a cosmetic inner cannula, and an obturator.
The cosmetic inner cannula may be used to provide a low-profile appearance; however, its use should be restricted in the hospital because it does not
provide a 15-mm connector, so it is impossible to connect to a manual resuscitation bag or ventilator. The capped inner cannula is used to provide a low-profile
appearance when a cap is in place. The outer aspect of the capped inner cannula is red for clear visibility.
Tracheostomies
58
Shiley DCFS
Structure: Dual-cannula, cuffless
Material: Rigid polyvinyl chloride
Manufacturer: Covidien
Unique Features: Disposable inner
cannula
Use: For the patient who can
protect his airway, yet secretions
may be a concern; when capped,
phonation can occur
Shiley DCFS tracheostomy tube (without inner cannula) (Covidien).
The Shiley DCFS tracheostomy tube is identical to the Shiley DCT tube except that it is cuffless. Like the DCT, the inner cannula is disposable and locks
in place with a clipping mechanism.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
TRACOE Twist Cuffless
Structure: Dual-cannula,
cuffless
Material: Flexible thermoelastic polyurethane
Manufacturer: Boston
Medical Products
Unique Features: Packaged with two inner
cannulas
Use: For the patient who
can protect his airway,
yet secretions may be a
concern; when capped,
phonation can occur
59
TRACOE Twist cuffless tracheostomy tube. Photo
courtesy of Boston Medical Products. All rights
reserved.
The TRACOE Twist cuffless tracheostomy tubes are made of medical-grade
polyurethane and are identical to the TRACOE Twist cuffed tubes, without the
cuff. It is packaged with two individual inner cannulas with 15-mm connectors.
Tracheostomies
60
TRACOE Comfort
TRACOE Comfort dual-cannula
tracheostomy tube (with additional inner
cannula). Photo courtesy of Boston Medical
Products. All rights reserved.
Structure: Uncuffed, single- or dual-cannula
Material: Flexible polyvinyl chloride
Manufacturer: Boston Medical Products
Unique Features: Clear
Use: When positive-pressure ventilation is not required
and secretions are not a concern
The TRACOE Comfort line of tracheostomies 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 15-mm adapters; however, one of the models (103.A) comes with a
15-mm adapter on the inner cannula so positive pressure can be used. Model
104 comes with a swivel speaking valve. Model 103 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. It should be used at least every other day to lubricate the inner cannula
and ensure it is easy to insert and remove.
Portex Lo-Profile Uncuffed
Structure: Dual-cannula, cuffless
Material: Polyvinyl chloride
Manufacturer: Smiths Medical
Unique Features: Clear neck flange and 15-mm connector; clear, low-profile, semireusable
inner cannula
Use: For the patient who desires a less conspicuous appearance
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
The Portex Lo-Profile tracheostomy tubes also come in cuffless versions.
For specific information about this tube, refer to the earlier section describing
the Portex Lo-Profile cuffed tracheostomy tube.
Single-Cannula Cuffed Tracheostomy Tubes
Single-cannula cuffed tracheostomy tubes are used for patients who require a
cuffed tube for airway protection or positive-pressure ventilation but for whom
secretions are not a major concern. Because there is no inner cannula, singlecannula tracheostomy tubes have a narrower outer diameter than comparably
sized dual-cannula tubes.
Shiley SCT
Structure: Cuffed, single-cannula
Material: Flexible polyvinyl chloride
Manufacturer: Covidien
Unique Features: Longer shaft than
comparably sized tube
Use: For the patient who requires a
cuff, yet for whom secretions are not a
concern; can also be used when a longer
tube is desired
61
Shiley SCT tracheostomy tube (Covidien).
The Shiley SCT is constructed of polyvinyl chloride but is more flexible
than standard Shiley tubes. It is the only Shiley tracheostomy tube without an
inner cannula, and as such the outer diameter is narrower than a comparable
dual-cannula tracheostomy tube. It is also distinctly longer than a comparably
sized Shiley DCT or LPC. As opposed to the standard Shiley tubes, the SCT uses
the ISO sizing system. The manufacturer recommends that no solution other
than saline be used to clean any part of the tube.