This is a standard trach tube, and its components. The trach tube is the main piece of a tracheostomy, and it is what you will primarily be dealing with in trach care. A tracheostomy (trach) tube is a curved tube that is inserted into a tracheostomy stoma (the hole made in the neck and windpipe (Trachea)). There are different types of tracheostomy tubes that vary in certain features for different purposes.  These are manufactured by different companies.  However, a specific type of tracheostomy tube will be the same no matter which company manufactures them.

A commonly used tracheostomy tube consists of three parts: outer cannula with flange (neck plate), inner cannula, and an obturator. The outer cannula is the outer tube that holds the tracheostomy open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or velcro strap around the neck. The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning. The obturator is used to insert a tracheostomy tube.  It fits inside the tube to provide a rounded end to the outer cannula that protects the trachea from damage when the trach tube is being inserted. Trach tubes come in different sizes depending on the patient and their airway requirements.

From top to bottom:

- Trach ties and neck flange

- The outer cannula

- Cuff

- Inflation tube

- Inner cannula (hollow)

- Obturator

Cuffed tube with disposable inner cannula

Used to obtain a closed circuit for ventilation

Recommendations for care:

Cuff should be inflated when using with ventilators. 

Cuff should be inflated just enough to allow minimal airleak.

Cuff should be deflated if patient uses a speaking valve.

Cuff pressure should be checked twice a day.

Inner cannula is disposable.

Cuffed tube with reusable inner cannula

Used to obtain a closed circuit for ventilation

Recommendatiosn for care:

Cuff should be inflated when using with ventilators. 

Cuff should be inflated just enough to allow minimal airleak.

Cuff should be deflated if patient uses a speaking valve.

Cuff pressure should be checked twice a day.

Inner cannula is not disposable.  You can reuse it after cleaning it thoroughly.

Cuffless tube with disposable inner cannula

Used for patients with tracheal problems

Used for patients who are ready for decannulation

Recommendations for care:

Save the decannulation plug if the patient is close to getting decannulated.

Patient may be able to eat and may be able to talk without a speaking valve.

Inner cannula is disposable

Cuffless tube with reusable inner cannula

Used for patients with tracheal problems

Used for patients who are ready for decannulation

Recommendations for care

Save the decannulation plug if the patient is close to getting decannulated.

Patient may be able to eat and may be able to speak without a speaking valve.

Inner cannula is not disposable. You can reuse it after cleaning it thoroughly.

Fenestrated cuffed tracheostomy tube

Used for patients who are on the ventilator but are not able to tolerate a speaking valve to speak

Recommendations for care:

There is a high risk for granuloma formation at the site of the fenestration (hole).

There is a higher risk for aspirating secretions.

It may be difficult to ventilate the patient adequately.

Fenestrated cuffless tracheostomy tube

Used for patients who have difficulty using a speaking valve

Recommendations for care:

There is a high risk for granuloma formation at the site of the fenestration (hole).

Metal tracheostomy tube

Not used as frequently anymore.  Many of the patients who received a tracheostomy years ago still choose to continue using the metal tracheostomy tubes.

Recommendations for care:

Patients cannot get a MRI.

One needs to notify the security personnel at the airport prior to metal detection screening.

Tracheostomy dressing gauze

Trach tubes have a dressing around them that is used to protect the skin.

The dressing should be changed when doing trach care (often done once or twice daily) or as needed.

Trach dressings should not be moist or soiled. 

Tracheosotomy care kit

Care kits will have slightly different components depending on the manufacturer, but you can expect certain things to be present, like in the kit featured here:

- One three-compartment tray 
- One pair gloves 
- One pre-cut gauze tracheostomy dressing 
- One polylined towel/drape 
- Four 4" x 4" gauze sponges 
- Four pipe cleaners 
- Two cotton-tipped applicators 
- One flexible, nylon bristle brush 
- One 36" twill tape

Gauze sponges are moistened with normal saline or sterile water and used to clean the area around the trach tube. The area must then be dried with a gauze sponge.

Pipe cleaners and brush are simply two different methods of cleaning a reusable inner cannula (if inner cannula is disposable, simply exchange with a clean one). Cotton-tipped applicators may also be used for this purpose.

Twill tape is used to replace old trach ties if they need it.

Trach care should be done while maintaining sterility.

Inner cannulas

Inner cannula is very important for patients especially when they have a lot of secretions. First of all, it is easier to pull the inner cannula out and clean it to maintain hygiene of the airway. Secondly, if patients develop a mucus plug, you can pull the inner cannula out and have the outer cannula serve as the airway. You can then either place a new inner cannula or clean the plug out of the old one and reuse it depending on whether the tube is disposable or not. Maintaining hygiene and management of emergent cannula blockages can become difficult if you do not have the inner cannula as changing the whole tracheostomy tube is more work and often uncomfortable for the patients.

For these reasons, most trach tubes today have inner cannulas.

For dual cannula tubes, the diameter of the inner cannula is the functional inner diameter. The outer diameter is the largest diameter of the outer cannula. Size fo the inner cannula is determined by overall size fo the trach tube. Many manufacturers colour code inner cannulas for size identification.

To remove the inner cannula, turn the inner cannula counter clockwise, then remove it. If the inner cannula has flange clips, pinch them and then remove the inner cannula. 

Speaking/Passy-Muir valve

The trach tube interferes with the normal voice process. It prevents air from the lungs from flowing over the voice box.

However, once a tracheostomy has matured, a speech therapist or other health professional will show a patient ways in which they can use their voice to speak clearly.

One option is a speaking valve that attaches to the trach tube. The Passy-Muir speaking valve is commonly used to help patients speak more normally. This one-way valve attaches to the outside opening of the tracheostomy tube and allows air to pass into the tracheostomy, but not out through it. The valve opens when the patient breathes in. When the patient breathes out, the valve closes and air flows around the tracheostomy tube, up through the vocal cords allowing sounds to be made. The patient breathes out through the mouth and nose instead of the tracheostomy.

Some patients may immediately adjust to breathing with the valve in place. Others may need to gradually increase the time the valve is worn. Breathing out with the valve (around the tracheostomy tube) is harder work than breathing out through the tracheostomy tube. Patients may need to build up the strength and ability to use the valve, but most children will be able to use the speaking valve all day after a period of adjustment.

Certain types of cuffed trach tubes also can help a patient speak. Doctors can widen or narrow cuffed tubes by inflating or deflating the cuffed part with air.

If a patient is using a ventilator, for example, the cuffed tube is inflated to fill the width of the airway. If they aren't using a ventilator, the tube can be deflated. This allows some air to enter the windpipe and pass over the voice box.

Heat moisture exchanger (HME)

A humidifying filter that fits onto the end of the trach tube and comes in several shapes and sizes. Also known by several other terms including: Thermal Humidfying Filters, Swedish nose, Artificial nose, Filter, Thermovent T.

Tracheostomy oxygen mask

People with tracheostomies may well require oxygen therapy, whether chronically or prn. If they do, a specially designed oxygen mask is used, rather than the typical nose-mouth mask.