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Tracheostomy Tube Sizes and Comparison Tool

Tracheostomy Sizes and Comparison Tool Compare different tracheostomy tube sizes for inner diameter, outer diameter, length and cuff NOTE: All Portex, Bivona, Uniperc, Tracoe, and…

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Tracheostomy Sizes and Comparison Tool

Compare different tracheostomy tube sizes for inner diameter, outer diameter, length and cuff

[TracheostomyTool]

NOTE: All Portex, Bivona, Uniperc, Tracoe, and Shiley Flexible Tracheostomy Tubes are ISO sizes. All other Shiley tubes use the Jackson sizing for the initial tube size selection.

Complete 14 Lessons
Adult Tracheostomy Care Webinar: Home Edition
katrina-cambigue 100% Complete Last activity on April 12, 2022 Adult Tracheostomy Care: Home Edition Webinar! 20% off until April 15th! Now available! Adult Tracheostomy Care: Home Edition is a 1 hour recorded webinar which provides information about performing tracheostomy care for adult patients in the home environment. Learn about suctioning, inner cannulas (disposable vs non-disposable), tracheostomy tube cleaning (if indicated), stoma care, cuff management, humidification and communication with the interdisciplinary team. Education is a main role of respiratory therapist in the home environment. Videos are used to aide in learner comprehension of tracheostomy care. A sample interdisciplinary communication form will be provided as well as home care guideline samples. Webinar objectives <ul> <li>Identify the indications for and complications of a tracheostomy</li> <li>Note the differences and limitations of tracheostomy care at home versus acute care</li> <li>Demonstrate how to perform trach care (inner cannula changes, site care, cuff management, suctioning)</li> <li>Identify the steps for tracheostomy tube changes</li> <li>Discuss patient/family education for humidification, oxygen, nebulizers, and mechanical ventilation with trachs.</li> </ul> Instructor: Katrina Cambigue BS, RCP, RRT-ACCS Katrina is a respiratory therapist at Kaiser Santa Rosa Pulmonary Rehab as well and a clinical instructor at Napa Valley Community College.
Start Course 0 Lessons
Tracheostomy Tubes Webinar: Comparisons and Choices
tracheducation 0% Complete 0/0 Steps Tracheostomy Tubes Webinar: Comparisons and Choices is a 2 hour recorded course that is all about different types of tracheostomy tubes and how to choose the most appropriate tracheostomy tube for your patient. Even those working with trach tubes for years will likely learn something new in this detail oriented course on trach tubes. In this course, the risk of inappropriate tracheostomy tubes based on the size and length will be provided. The course will also provide information on different trach tube materials, size, length, cuff type, cuff vs cuffless, single vs double cannula, fenestrated, subglottic suctioning and custom tubes. The Tracheostomy Tubes Webinar will provide information on patient candidacy for the types of tubes.

Complete 14 Lessons
Adult Tracheostomy Care Webinar: Home Edition
katrina-cambigue 100% Complete Last activity on April 12, 2022 Adult Tracheostomy Care: Home Edition Webinar! 20% off until April 15th! Now available! Adult Tracheostomy Care: Home Edition is a 1 hour recorded webinar which provides information about performing tracheostomy care for adult patients in the home environment. Learn about suctioning, inner cannulas (disposable vs non-disposable), tracheostomy tube cleaning (if indicated), stoma care, cuff management, humidification and communication with the interdisciplinary team. Education is a main role of respiratory therapist in the home environment. Videos are used to aide in learner comprehension of tracheostomy care. A sample interdisciplinary communication form will be provided as well as home care guideline samples. Webinar objectives <ul> <li>Identify the indications for and complications of a tracheostomy</li> <li>Note the differences and limitations of tracheostomy care at home versus acute care</li> <li>Demonstrate how to perform trach care (inner cannula changes, site care, cuff management, suctioning)</li> <li>Identify the steps for tracheostomy tube changes</li> <li>Discuss patient/family education for humidification, oxygen, nebulizers, and mechanical ventilation with trachs.</li> </ul> Instructor: Katrina Cambigue BS, RCP, RRT-ACCS Katrina is a respiratory therapist at Kaiser Santa Rosa Pulmonary Rehab as well and a clinical instructor at Napa Valley Community College.
Start Course 0 Lessons
Tracheostomy Tubes Webinar: Comparisons and Choices
tracheducation 0% Complete 0/0 Steps Tracheostomy Tubes Webinar: Comparisons and Choices is a 2 hour recorded course that is all about different types of tracheostomy tubes and how to choose the most appropriate tracheostomy tube for your patient. Even those working with trach tubes for years will likely learn something new in this detail oriented course on trach tubes. In this course, the risk of inappropriate tracheostomy tubes based on the size and length will be provided. The course will also provide information on different trach tube materials, size, length, cuff type, cuff vs cuffless, single vs double cannula, fenestrated, subglottic suctioning and custom tubes. The Tracheostomy Tubes Webinar will provide information on patient candidacy for the types of tubes.

The Tracheostomy Tube Size and Comparison Tool allows the user to easily see the inner diamter, outer diameter, and length of various tracheostomy tubes. You can also compare two different tracheostomy tubes by clicking the button to "on" in the upper right side of the tool. The tool provides a look at many common tracheostomy tube manufacturers including Shiley, Portex, Bivona, and Tracoe tracheostomy tubes.

Sizing of the Tracheostomy Tube

Choosing the appropriate inner and outer diameter sizes of the tracheostomy tube are important when recommending the initial tracheosotmy tube size or tracheostomy tube changes. When determining the appropriate diameter of the tracheostomy tube, there are a few aspects to consider: lung mechanics, upper airway resistance and airway clearance, ventilation and communication/speech needs, and indications for the procedure (Mitchelle, 2013). These requirements may change over time.

Sizing is important when recommending tracheostomy tube changes. A tracheostomy tube from one manufacturer may not correspond to the same size from a different manufacturer as they may have different internal/external diameters or length. A clinician recommending downsizing needs to be aware that one size 6 tracheostomy tube is not necessarily the same inner/outer diameter or length as a different brand of size 6 tracheostomy tube. The clinician should assess the inner and outer diameter measurements and length to compare the tracheostomy tubes and ensure the appropriate selection. The above comparison tool can help to show the differences between tracheostomy tubes.

ISO versus Jackson Tracheostomy Tube Sizing

It is also important to understand that different manufacturers follow different sizing guidelines. Some tracheostomy tubes utilize the Jackson sizing system, while other tubes use the International Organization for Standardization (ISO) method. With the exception of Shiley Flexible Tracheostomy Tubes, the Shiley dual cannula tracheostomy tubes still use the Chevalier Jackson sizing system. The appropriate dimensions are listed on the flange of the tracheostomy tube. You can also find the dimensions on the tool above.

ISO is a worldwide federation of national standardization bodies that is concerned with the basic requirements and method of size designation of tracheostomy tubes made of plastics or rubber. It requires that tracheostomy tubes are sized according to the most narrow part of the inner diameter which includes the inner cannula if it is required to connect to the ventilator circuit. The inner diameter of the outer cannula is used for tubes with a single cannula. The inner diameter of the inner cannula is used if that tube requires the inner cannula to connect to mechanical ventilation. The outer cannula is measured as the largest diameter of the outer cannula.

A duplicate tracheostomy tube and a size smaller should be kept at bedsideSince sizing between manufacturers of tracheostomy tubes varies, it is recommended that the exact duplicate of the tracheostomy tube be kept at bedside for replacement if needed. One size smaller should also be kept at bedside in case of emergency. If the tracheostomy tube is not cuffed, a tracheostomy tube the same size, cuffed should also be at bedside.

It is important when selecting an appropriate tube to understand the differences in sizing. There is an unavoidable compromise to be made between a desire to maximize the functional internal diameter (and thereby reduce airway resistance and the work of breathing during weaning) and a need to limit the OD to approximately three-quarters of the internal diameter of the trachea (in order to facilitate airflow through the upper airway when the cuff is deflated). When the cuff is inflated, a smaller inner diameter will increase the resistance through the tube and airway clearance may be more difficult. Furthermore, if the tube selected is too small, the cuff may need to be overinflated to maintain positive pressure ventilation. Complications from overinflating the cuff can result in tracheal damage such as necrosis and stenosis. However with a deflated cuff, the individual will also be breathing around the tracheostomy tube and therefore the size of the inner diameter is less important. With a speaking valve or cap in place, a smaller outer diameter will allow for easier exhalation around the tracheostomy tube and through the upper airway.

Tracheostomy Tube Length

The length of the tracheostomy tube may also vary between tubes of the same inner diameter for different manufacturers. These variations are not commonly appreciated, but may have important clinical implications. If the tracheostomy tube is too short, the end of the tube can hit against the posterior tracheal wall.

Tracheostomy tubes are available in standard lengths or extra lengths. Extra length tracheostomy tubes can be constructed with extra proximal length or distal length.

Extra proximal length tubes are for patients with thicker necks (obese patients). Standard tracheostomy tubes are too short and too curved for proper positioning due to the distance between the skin and the trachea. Therefore, standard tracheostomy tubes are more likely to be dislodged in patients with thick necks.

Extra distal length tubes are used to bypass tracheal anomalies such as stenosis or malacia. A study by Rumbek (1999) of 37 patients with substantial tracheal obstruction caused failure to wean. Insertion of a longer tracheotomy tube relieved the obstruction and allowed 35 out of 37 patients to be weaned from the ventilator within 1 week.

Shiley XLT proximal tracheostomy tube — Extra Length (XLT) Proximal for those with full and thicker necks-

Shiley XLT distal — Extra Length (XLT) Distal for those with tracheal anomolies, trachea stenosis, tracheal malacia

There are also adjustable tracheostomy tubes which have a movable flange so that the length of the tracheostomy tube from skin surface to trachea can be adjusted at the bedside. A locking mechanism on the flange maintains the chosen tube length. These tubes are used for patients with atypical anatomy. The locking mechanism often fails after a period of time and therefore these tubes are for short term use. Custom tubes are available with fixed flanges that can be made with specific sizes on an individual basis.

Tracheostomy Tube Curvature

Tracheostomy tubes can be curved or angled. These features can help to improve the fit of the tracheostomy tube into the airway. Patients with a fenestrated tracheostomy tube may need a particular angled tracheostomy tube so that the fenestration fits in an appropriate place in the trachea, and not against the anterior or posterior tracheal wall.

Summary

Not all tracheostomy tubes are created equally. A tracheostomy tube is not a one size fits all. Each patient should be assessed individually to best meet his or her needs. Clinicians should understand the differences in sizing and comparisons between the tracheostomy tubes. A tracheostomy manikin such as the one below can help to provide education on various tracheostomy tubes and sizing. The clear trachea size is a typical adult size and a pediatric size is also available.

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Tracheostomy Tube Sizes and Comparison Tool

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Tracheostomy Sizes and Comparison Tool

Compare different tracheostomy tube sizes for inner diameter, outer diameter, length and cuff

Adult Tracheostomy Care Webinar: Home Edition

Tracheostomy Tubes Webinar: Comparisons and Choices

Adult Tracheostomy Care Webinar: Home Edition

Tracheostomy Tubes Webinar: Comparisons and Choices

Sizing of the Tracheostomy Tube

ISO versus Jackson Tracheostomy Tube Sizing

Tracheostomy Tube Length

Tracheostomy Tube Curvature

Summary

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