The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [372]
A selection of tube types and commonly seen tubes is described below.
Cuffed tracheostomy tubes
Portex® blue line and portex® blue line ultra® cuffed tracheostomy tubes
These are single-use tracheostomy tubes constructed of siliconized polyvinyl chloride with an introducer and inflatable cuff of ‘high-volume/low-pressure’ design (Figure 10.14). They are softer and more pliable and are often used when percutaneous tracheostomy is performed in the critical care setting. The cuff pressure should be monitored regularly. Once the stoma is well-formed, after about 7–10 days and depending on the patient’s specific weaning needs, the Portex® tube may be replaced by a more suitable, sturdier tube such as a Shiley® tube (Hess 2005).
Figure 10.14 Portex cuffed tube.
Shiley® cuffed tracheostomy tube
This is a plastic tube with an introducer and one inner tube (Figure 10.15a). The inner tube has the universal 15 mm extension at its upper aspect to facilitate connection to other equipment. The outer tube has an inflatable cuff to give an airtight seal and facilitate ventilation and prevention of aspiration. Shiley® tubes are often used in the immediate postoperative phase, that is, at 24–72 hours. As with all cuffed tracheostomies, the internal cuff pressure should not exceed 25 cmH2O (ICS 2008) and should be monitored on a regular basis. The cuff should be deflated to remove the tube (to prevent mucosal damage and allow the tube to be removed safely) when the patient is eating and drinking, or when a speaking valve or decannulation plug is in situ (ICS 2008). Failure to deflate the cuff when a speaking valve or plug is in place will result in complete occlusion of the patient’s airway.
Figure 10.15 (a) Shiley cuffed tube. (b) Shiley plain tube. Courtesy of Tyco Healthcare. (c) Shiley plain fenestrated tube. (d) Shiley cuffed fenestrated tube.
Courtesy of Tyco Healthcare.
Cuffless tracheostomy tubes
Shiley® cuffless tracheostomy tube
This is a plastic tube with an introducer and two inner tubes (Figure 10.15b). One inner tube has an extension known as a 15 mm hub or adaptor at its upper aspect. The majority of tracheostomy tubes used in the hospital setting have the universally sized 15 mm hub to allow attachment to speaking valves and other equipment (Russell 2004). The other tube has no 15 mm hub extension and is less obtrusive and suitable for those patients not requiring attachment to other equipment (Russell 2004).
A cuffless Shiley® tube is usually used for the following reasons.
To keep the tracheostomy tract patent if the patient is going to have further surgery.
In place of a metal tracheostomy tube if the patient is going to have radiotherapy to the neck area (Prior and Russell 2004). Keeping the metal tube in situ during radiotherapy can cause reactions due to interference of the metal with the radiotherapy beam and leads to an increased dose being given to the underlying stoma and surrounding skin (Prior and Russell 2004).
For a laryngectomy patient who has a benign or malignant stenosis of the trachea and requires a longer tube than the regular length laryngectomy tube to keep the stenosis patent.
Fenestrated tracheostomy tubes
Shiley® fenestrated cuffless tube
The Shiley fenestrated cuffless tube (Figure 10.15c) is a plastic tube with an introducer and three inner tubes. One inner tube has no hub jutting out, is less obtrusive and is suitable for those patients not requiring attachment to other equipment (Russell 2004). The other two inner tubes have the universal 15 mm extension at the upper aspect to facilitate connection to other apparatus, and one of these (with a green coloured hub) also has a fenestration midway down the tube (the clear or white hubbed inner has no fenestrations down the side