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Commonly Asked Questions About Tracheostomies

What is a "trach?" What is a "cuff?" In what sizes are trach tubes available? What is a fenestrated trach? Common Tracheostomy terms What happens while recovering from the tracheostomy surgery? What complications occur after a tracheostomy? What is a low pressure trach? How can Vitality Medical help with my tracheostomy recovery?

What is a "Trach?"

A "trach tube" is a breathing tube that is surgically inserted into the trachea of the neck. Once in the trachea, the trach tube provides an artificial airway for mechanical ventilation. Trach tubes are used when normal breathing has been compromised from trauma or disease. Trach tubes are also often used during surgical procedures.

What is a "Cuff?"

The trach tubes are inserted below the speaking chords and have a sack/bubble (also called a "cuff") which fills with air and seals the airway. Once the the airway is sealed, the person cannot speak unless the cuff is deflated so that air is able to above the trach tube. The trach tube cuff also prevents liquid or particles from the mouth to pass down the trach tube and cause an infection. Cuffs are particularly necessary when a person has been unconscious, a swallow deficit, altered mental status, or a compromised breathing status.

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In What Sizes Are Trach Tubes Available?

Trach tubes are available in various sizes(measured in millimeters) and styles. The size of the trach tube is measured by the diameter of the hole used. For adults, a 7 or 8 size is generally appropriate, while children typically use a 4. Neonates require an even smaller trach tube. After a person has been on a trach for a period of time, a physician will often down size the trach to wean the person from the trach to normal breathing.

However, the latest trend is to use a fenestrated trach and speaking valve (passy muir valve) which is a one-way valve that lets air through the trach but not out. This forces air up the trach tube through the fenestrated holes and allows the air to pass by the vocal chords and out of the mouth. This allows a person to speak and breathe in through the trach.

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What is a Fenestrated Trach?

A fenestrated trach has holes around the tube so that air may pass around the tube and above the trach to simulate normal breathing.

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Common Tracheostomy Terms

Awake Tracheostomy: a type of tracheostomy done when the patient is undergoing acute respiratory distress.

Bovena: Type of cuff that is a sponge rather than an air filled sack.

Cuff: A sack at the bottom of the trach tube that is filled with air using a small syringe. The syringe connects to the sack through a tube and the amount of air that can be varied for an appropriate fit. To get an appropriate fit, respiratory therapists and nurses monitor the pressure with a special gauge so the cuff is not overinflated, but is inflated enough to seal the airway so that air or fluid does not pass around the cuff.

DCT: Disposable Cuff Tub.

DCFN: Disposable Fenestrated Tracheostomy Cannula.

DCFS: Disposable Tracheostomy Cannula.

DFEN: Disposable Fenestrated Tube.

DIC: Disposable Inner Cannula.

Disconnect Wedge: Designed to help remove the trach from the insertion site more easily.

DPRV: Disposable Cannula with Pressure Relief Valve

Elective Tracheostomy: the most common tracheostomy performed; usually done under the supervision of a surgeon and an anesthesiologist.

Emergent Tracheostomy: a type of tracheostomy only done in the most extreme circumstances.

Inner Cannula: A tube that fits inside a trach and is removable so the inner tube may be cleaned. Because the inner tube can become clogged with debris, inner tubes are changed or cleaned daily. Inner cannulas can be disposable or re-usable.

Obturator: a device worn in the mouth that decreases the amount of air coming through the nose while the patient is speaking.

PERC: Percutaneous tracheostomy. Similar to a standard tracheostomy, Percutaneous tracheostomies use a needle guide wire to gain airway access.

Shilley: Also called a standard trach. Can be fenestrated or non-fenestrated. Also available in cuffed or non-cuffed versions.

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What Happens While Recovering From a Tracheostomy?

Medline Encyclopedia reports that it takes about 1 to 3 days to adapt to the trach tube and learn how communicate. Four to ten days after surgery the tube inserted during is replaced. As mentioned earlier, the trach tube is either replaced with a smaller one, or a fenestrated tube with a passy-muir speaking valve is used. Before going home, a physician or staff will give instructions on trach tube maintenance and cleaning. Make sure you or the caretakers are familiar with the procedures. Always follow the physician or specialist recommendations regarding air, water, and food contamination.

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What Complications Occur After a Tracheostomy?

Answers.com divides tracheostomy complications into two categories: early and late. Early(1-3 days) tracheostomy complications include bleeding, inflammation of the trachea and the incision site, and tube displacement. Late(7+ days) tracheostomy complications include bleeding, abnormal connection between trachea and esophagus as well as between the trachea and the surface of the neck, and the formation of scar tissue. Despite these occasional complications, tracheostomies can be a safe procedure when done with qualified care.

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What is a Low Pressure Trach?

A low pressure, low volume(LVLP) trach avoids a method of leakage that high volume, high pressure(HVLP) trachs are known to have. Low pressure trachs are not for everyone, so check with your physician or respiratory specialist before using a low pressure trach.

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How Can Vitality Medical Help With My Tracheostomy Recovery?

Vitality Medical has several products that can help with tracheostomy home care, including trach tubes. We carry fenestrated, cuffless, low-pressure, and DIC trach tubes made by respected manufacturers such as Mallinkrodt, Biovana Medical, and Sims Portex. Because trach tubes accumulate small debris over time, it is necessary to clean daily. We have tracheostomy care trays that include many of the things needed for tracheostomy care, including: solution bases, pipe cleaners, pre-cut trach dressings, twill tape, and cotton applications. We also carry a trachea brush from DeRoyal, which is specially designed for trach cleaning. For easy showering and bathing, we carry a shower shield by Medmart. Back to top

Sources

Medline Plus Medical Encyclopedia - Tracheostomy

Medicinet - Tracheostomy Family Support Dictionary IPCSINTOX Databank Centre National De La Rescherche Scientifque

Answers.com - Tracheostomy Medindia.net

Emedicine - Percutaneous

Tracheostomy

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