Cuffed versus Cuffless Tracheostomy Tubes

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What is a cuffed tracheostomy tube?

A cuffed tracheostomy tubes has a balloon-like feature at the distal end of the tube.  There are three main types of cuffs:  low-pressure cuffs, low-volume cuffs and foam-filled cuffs.  

 

What is the purpose of the cuff of the tracheostomy tube?

Regardless of the type of cuffed tracheostomy tube, the purpose of the cuff is to maintain the air delivered from the mechanical ventilator to the lungs.  It may be necessary to keep the cuff of the tracheostomy tube inflated so all the air delivered from the ventilator goes to the lungs and then back to the ventilator on exhalation to be measured and monitored.  This is often the case during the acute disease process.  Once the patient is stabilized, the cuff may be deflated or the tube may be changed to a cuffless tracheostomy tube.  

It is a common misconception that the cuff of the tracheostomy tube prevents aspiration.  The definition of aspiration is any material that passes below the level of the vocal folds.  The cuff is located below the level of the vocal folds.  So any material that reaches the cuff has already been aspirated.  The cuff does not form an impenetrable seal and therefore aspirated material that reaches the cuff, passes around the cuff and into the lower airways.  

Cuffed pressure should be checked regularly.  High cuff pressure can lead to mucosal ischemia and eventual injury with complications such as tracheal stenosis, necrosis, bleeding, ulcers, and fistulas.  

How do you determine if the patient has a cuffed tracheostomy tube?

If the tracheostomy tube has a pilot line and pilot balloon, this is an indicator that the patient has a cuffed tracheostomy tube.  The flange of the tracheostomy tube also indicates if the tracheostomy tube has a cuff in place.  

 When the pilot balloon is inflated, this indicates that the cuff is inflated.  When the pilot balloon is deflated, this indicates that the cuff is deflated.  Prior to placing a speaking valve or cap, always use a syringe to remove all air from the pilot balloon to make sure that the cuff is fully deflated.  If the cuff is not completely deflated, the patient may have difficulty breathing with a valve in place.  

What is a cuffless tracheostomy tube?

A cuffless tracheostomy tube does not have a cuff (balloon like feature) at the end of the tube. If the patient does not that the air from the ventilator is monitored and measured and is able to tolerate cuff deflation without respiratory distress, then a cuff less tracheostomy tube may be placed.  

When a cuffless tracheostomy tube is place, the flow of air is different then with a tracheostomy tube with an inflated cuff.  With a cuffless tracheostomy tube air will flow in and out of the tracheostomy tube, however, air may also leak around the tracheostomy tube and through the upper airway.  

A cuffless tracheostomy tube does not have a pilot line or pilot balloon.  The flange of the tracheostomy tube will indicate that the tracheostomy tube is cuff less.  

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