Tracheostomy tube parts

• Cannula
• Outer cannula - flange ± cuff for stability
• Cuffed tube - required for positive pressure ventilation to prevent air leak. Mucosal pressure.
• Will see a “pilot balloon” outside
• Uncuffed tube - non-ventilated patients. 
• Inner cannula - easily removable for cleaning secretions/mucus plugs (don’t have to replace entire tube)
• Obturator - facilitates insertion of inner cannula
• Stoma button - no cannula (less irritation) but easier to dislodge. 
• Larytube provides more stability
• HME: Heat and Moisture Exchange cassette to replace nasal function - humidify, warm, and filter
• Reduces secretions/mucus

Ventilation/Intubation

• Laryngectomy or tracheostomy?
• Total laryngectomy - RED sign above bed - must intubate through stoma (no connection between mouth and larynx)
• Tracheostomy/partial laryngectomy - can still intubate through mouth
• If ventilating upper airway, should occlude stoma
• If there is already a tube in place, remove the inner cannula. 
• Use an endotracheal tube one size smaller, or 6.0 ETT

Communication

• Occlude port -> air is forced upwards through vocal cords for phonation (cuff must be deflated)
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• Passy-Muir valve - one-way valve. More effort for expiration.
• Total laryngectomy
• Electrolarynx - handheld device transmits vibrations through soft tissue of jaw/cheek
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• Esophageal speech - vibration of pharyngoesophageal segment
• Tracheoesophageal puncture (TEP) - most similar to normal speech. Occlude stoma → shunt air across unidirectional TEP valve into pharyngoesophagus. Average device life 30-60 days before leakage.
• Visible through stoma; avoid dislodging TEP prosthesis during intubation
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