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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4597_Библиотеки_им_академика_М_И_Перельмана.pdf
Tracheostomies
62
Portex Blue Line
Structure: Cuffed, single-cannula, 90-degree curvature 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 requires a cuff, yet for
whom secretions are not a concern; however,
a separate inner cannula can be used when
necessary
Portex Blue Line cuffed tracheostomy tube. Photo
courtesy of Smiths Medical.
The Portex Blue Line series of tracheostomy tubes is 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 cuffed tracheostomy
tube is recognizable by its soft, flexible blue neck flange and shaft as well as its
blue pilot balloon and inflation line. The Blue Line tracheostomy tubes have
a 90% curvature to the shaft, and the inflation line is buried within the outer
cannula. The Blue Line tracheostomy tube has a teardrop shaped cuff, which is
thought to allow better placement of the tube within the airway.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
Portex Blue Line Ultra
Structure: Cuffed, 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 requires a cuff, yet
for whom secretions are not a concern
63
Portex Blue Line Ultra cuffed tracheostomy tube. Photo
courtesy of Smiths Medical.
The Portex Blue Line Ultra series of tracheostomy tubes is very similar to
the standard Portex Blue Line tubes but with 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 tracheostomy tubes.
There is also a type of Blue Line Ultra tracheostomy tube that provides an
extra port for subglottic suctioning of secretions that accumulate above the cuff
(Suctionaid). One of the most unique features of the Blue Line Ultra is the presence of a central channel through the obturator that can accommodate a guide
wire for insertion.
Tracheostomies
64
Bivona Mid-Range Aire-Cuf
Bivona Mid-Range Aire-Cuf
tracheostomy tube. Photo courtesy
of Smiths Medical.
Structure: Cuffed, single-cannula
Material: Silicone
Manufacturer: Smiths Medical
Unique Features: 360-degree swivel adapter; soft, “low-trauma” tip
Use: For the patient who requires a cuff, yet for whom secretions
are not a concern
The Bivona Mid-Range Aire-Cuf tracheostomy tube has a flexible neck
flange, a white inflation line, and a blue pilot balloon.
All of the Bivona tracheostomy tubes, regardless of the line, are constructed
entirely of silicone and are more flexible. The theoretical advantage to silicone
is that secretions are less likely to adhere to the material; however, no studies
have been done to verify this claim. All Bivona tracheostomy tubes are singlecannula tubes and have 360-degree swivel adapters to accommodate some
patient movement. Bivona tracheostomy tubes also come with a disconnect
wedge, which is helpful because the 15-mm swivel connector can sometimes
get wedged into the adaptor of a manual resuscitation bag or ventilator tubing.
The forceful removal of any device from a Bivona tracheostomy tube can result
in permanent damage to the tube, so the use of the disconnect wedge is advised
whenever removing any device from this tube.
There have been two important manufacturing changes to adult Bivona tracheostomy tubes. First, the swivel mechanism has been replaced with a singlemolded piece as the 15-mm connector. Second, the solid obturators have been
redesigned to be hollow. This redesign supports the introduction of a guide wire
as a tube exchanger (personal communication Mark Lareau, Smiths Medical,
November 2008).
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
Arcadia Silicone Air Cuff
Structure: Cuffed, single-cannula,
wide arch curvature
Material: Flexible silicone
Manufacturer: Arcadia Medical
Corporation
Unique Features: 360-degree
swivel adapter; angled design
allows tube to be centered within
the airway
Use: For the patient who requires
a cuff, yet for whom secretions
are not a concern
65
Arcadia Air Cuff tracheostomy tube. Latex free. Arcadia Medical
Corporation, www.arcadiamedical.com.
The Arcadia line of tracheostomies is new to the United States as of January
2009. The line is constructed of silicone and consists of single-cannula tracheostomy tubes. The neck flange has a 15-mm swivel connector, and a disconnect
wedge is included to facilitate the removal of respiratory equipment.
The curvature of many of the Arcadia tracheostomy tubes is unique in that
they have a more horizontal orientation to the proximal portion of the shaft
while the distal portion has a more vertical orientation, giving a 90-degree
angle to the tube.
Tracheostomies
66
Bivona Fome-Cuf
Structure: Cuffed, single-cannula
Material: Silicone
Manufacturer: Smiths Medical
Unique Features: Foam-filled cuff that
expands automatically to fit tracheal
diameter
Use: For the patient who has repeated
cuff leaks and does not desire to speak
Bivona Fome-Cuf tracheostomy tube. Photo courtesy of Smiths
Medical.
The Bivona Fome-Cuf tracheostomy tube is constructed entirely of silicone.
The Fome-Cuf tube is unique in that it provides a large, self-inflating cuff that
adjusts itself to the patient’s trachea. Once in place, the pilot balloon should
remain open to air at all times, and no additional air should be injected into this
cuff. This tracheostomy tube is inserted by first deflating the cuff completely.
Because of the extra-large cuff, this is often best done with the large syringe
and three-way stopcock that come in the tracheostomy kit. The deflated cuff is
particularly bulky; however, when inflated it is usually able to provide a complete seal within the airway.
The Fome-Cuf tracheostomy tube is often chosen when positive-pressure
ventilation is required, yet because of this a good seal is difficult because of a
continued leak around the outside of the tracheostomy tube. Over time, moisture may collect within the cuff especially when using the ventilator adapter,
so routine cuff deflation is recommended every 8 hours. It is recommended that
this tracheostomy tube be routinely changed at least every month to minimize
the collection of moisture and debris and prevent solidification within the cuff.
If the ventilator tubing should become difficult to remove from the 15-mm
connector of the tube, the Fome-Cuf tube has a disconnect wedge that can be
used as a lever to simplify removal. Forceful attempts to remove the tubing can
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
result in damage to the tracheostomy tube itself. The manufacturer’s recommendations state that these tracheostomy tubes should not be used with lasers
or electrosurgical devices.
Arcadia Foam Cuff
Structure: Cuffed, single-cannula
Material: Flexible silicone
Manufacturer: Arcadia Medical
Corporation
Unique Features: Foam-filled cuff
that expands automatically to fit
tracheal diameter
Use: For the patient who has
repeated cuff leaks and does not
desire to speak
67
Arcadia Foam Cuff tracheostomy tube. Latex free. Arcadia Medical
Corporation, www.arcadiamedical.com.
The Arcadia Foam Cuff tube is made of silicone with an auto-expandable
cuff. The neck flange has a 15-mm swivel connector. The Arcadia tubes also
have disconnect wedges to simplify the removal of any respiratory equipment.
Tracheostomies
68
Bivona TTS (Tight-to-Shaft)
Structure: Cuffed, single-cannula
Material: Silicone
Manufacturer: Smiths Medical
Unique Features: When this high-
pressure cuff is deflated, it lies tight
to the shaft, minimizing resistance
when breathing around the tube (when
prolonged cuff inflation in desired, it
should be inflated with sterile water);
other than the Arcadia CTS tube, the
TTS tracheostomy tube is the only
cuffed tube that may be safely capped
when deflated
Use: Ideal for the patient who requires
intermittent positive-pressure ventilation yet who also desires to speak
Bivona TTS tracheostomy tube. Note deflated cuff that lies
snugly against the shaft of the tube. Photo courtesy of Smiths
Medical.
The Bivona Tight-to-Shaft, or TTS, tracheostomy tube is constructed of silicone material and provides some flexibility. It is a single-cannula tracheostomy
tube whose most notable feature is its cuff, which, when deflated, lies tight to
the shaft of the tube—hence its name. The TTS is ideally suited for the patient
who may require intermittent cuff inflation (perhaps for nocturnal ventilation)
yet who wishes to speak at intervals when the cuff is deflated. The TTS design
provides laminar flow around the outside of the tube, so it can be capped to
allow phonation. (The details of phonation will be discussed in chapter 6.) It is
important to note that the cuff of the TTS is a high-pressure cuff, so precautions
must be taken to minimize pressure against the tracheal wall. This is best done
with the minimal leak technique.
The cuff of the TTS tracheostomy tube is inflated with sterile water (not saline) in order to minimize gas permeability across the cuff that might otherwise
result when air is used for cuff inflation. This gas permeability is manifested
as cuff deflation over time. The TTS tracheostomy tube is packaged with a disconnection wedge to be used in case the ventilator tubing becomes difficult to
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
remove from the 15-mm connector. If force is used, the TTS tracheostomy tube
can become damaged.
Arcadia Silicone CTS Cuff (Close-to-Shaft)
Structure: Cuffed, single-cannula,
curved shaft
Material: Silicone
Manufacturer: Arcadia Medical
Corporation
Unique Features: When the highpressure cuff is deflated, it lies close
to the shaft, minimizing resistance
when breathing around the tube (when
prolonged cuff inflation is desired, it
should be inflated with sterile water);
the CTS tracheostomy tube is one of
only two cuffed tracheostomy tubes that
may be safely capped when deflated
(the other is the Bivona TTS)
Use: Ideal for the patient who requires
intermittent positive-pressure ventila-
Arcadia Silicone CTS Cuff tracheostomy tube. Note deflated
cuff lying snugly against the shaft of the tube. Arcadia Medical
Corporation, www.arcadiamedical.com.
tion yet who also desires to speak
69
The Arcadia Silicone CTS Cuff tracheostomy tube has a radiopaque silicone shaft with a curved design to make insertion and removal easier. It has a
silicone cuff that lies flat against the shaft when deflated. Like the Bivona TTS,
it is a single-cannula tracheostomy tube with a high-pressure cuff, and its cuff
should be inflated with sterile water.
Single-Cannula Cuffless Tracheostomy Tubes
Single-cannula cuffless tracheostomy tubes are used when exclusive breathing through the tube is not necessary (or not desired) and secretions are not a
concern.
Tracheostomies
70
Bivona Uncuffed
Bivona uncuffed tracheostomy
tube. Photo courtesy of Smiths
Medical.
The Bivona uncuffed tracheostomy tube is a single-cannula tube and is
composed of silicone. The neck flange is flexible, and the 15-mm connector has
a swivel mechanism that accomodates some patient movement.
Structure: Cuffless, single-cannula
Material: Silicone
Manufacturer: Smiths Medical
Unique Features: Swivel mechanism of 15-mm adapter
Use: When positive-pressure ventilation is not required and secretions
are not a concern
Air-Lon Tracheostomy Tube and Inhalation Set
Air-LonTM tracheostomy tube. Premier Medical
Products Company.
Structure: Uncuffed, single-cannula; 90-degree curvature to the shaft
Material: Nylon
Manufacturer: Premier Medical Products
Unique Features: Low-profile inner cannula
Use: When positive-pressure ventilation is not required and secretions are not a concern
Air-LonTM inhalation set. Premier Medical Products
Company.
Chapter 3 Types of Tracheostomy Tubes and Related Appliances
The Air-LonTM tracheostomy tube is cuffless and made of nylon. The outer
cannula has a 90-degree arc. It comes with an obturator and low-profile inner
TM
cannula. If positive-pressure ventilation is desired, the Air-Lon
Inhalation
Set can be used.
TRACOE Comfort
Structure: Uncuffed, single- or dual-cannula
Material: Flexible polyvinyl chloride
Manufacturer: Boston Medical Products
Unique Features: Clear, flexible material; low-profile
appearance
Use: When positive-pressure ventilation is not required and secretions are not a concern
71
TRACOE Comfort single-cannula tracheostomy
tube. Photo courtesy of Boston Medical Products.
All rights reserved.
The TRACOE Comfort line of 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. The TRACOE Comfort single cannula
(Model 101) is a single-cannula tube that is low profile in nature. Paraffin oil
should be used to lubricate the inner cannula within the outer cannula.