Fenestrated vs Unfenestrated Tracheostomy

fenestrated tracheostomy tubes

There is a small but important difference between fenestrated and unfenestrated tracheostomy tubes.  Understand the difference, how to tell if a tracheostomy tube is fenestrated or unfenestrated and when to use each type of tube.  It is important for the clinician caring for an individual with tracheostomy to understand the differences and select the appropriate tube for the patient.

In order to understand the difference between fenestrated and unfenestrated tracheostomy tubes and how these tubes work, it is first important to understand how to breathe with a tracheostomy tube in place.  When a tracheostomy tube is cuffed, air flows in and out through the tracheostomy tube and into the lungs.  Most air does not pass around the cuff and through the vocal folds.  Therefore the person is not able to vocalize.

What is the difference between fenestrated and unfenestrated tracheostomy tubes?

The big difference between fenestrated vs unfenestrated tracheostomy tubes is that a fenestrated tracheostomy tube has a small hole or multiple holes  in the shaft of the tracheostomy tube, above the cuff (if present).  These small openings allow for increased airflow through the upper airway.  Air can move through the upper airway even when the cuff of the tracheostomy tube is inflated.  This may allow for some voicing when the cuff is inflated.  

The use of a fenestrated inner cannula is required to achieve the benefits of the fenestrated tracheostomy tube.  A regular non-fenestrated inner cannula will occlude the fenestrations, and thus air will not pass through the upper airway.

fenestrated tracheostomy tubes

Fenestrated tracheostomy tubes may also be used when the cuff is deflated if the individual can tolerate cuff deflation.  This will allow the passage of air through the fenestrations as well as around the tracheostomy tube.  There are also uncuffed, fenestrated tracheostomy tubes, which do not have a cuff in place.  Uncuffed, fenenestrated tracheostomy tubes allow for the most airflow through the upper airway with the least resistance. 

Learn more about the difference between cuffed and cuffless tracheostomy tubes.  

Uncuffed, fenestrated tracheostomy tubes are sometimes used when an individual is getting close to decannulation.  It allows for the maximum amount of airflow through the upper airway when the tracheostomy tube is occluded either with a speaking valve or cap. However, these tubes come with complications, which must be taken into consideration. Supplemental oxygen through the nasal passages may be necessary when the tube is capped. 

NOTE:  It is important to make sure the patient has either a cuffless tracheostomy tube or that the cuff is fully deflated prior to use of a speaking valve or cap.  Do NOT use a speaking valve or cap when the cuff is inflated, even with a fenestrated tracheostomy tube in place, as there will be limited space for the exhaled air to escape through the upper airway.  A cuffless tracheostomy tube is recommended prior to capping. 

Unfenestrated tracheostomy tubes do not have small openings in the shaft of the tracheostomy tube.  Therefore little to no voicing occurs when the cuff is inflated.  When the cuff is deflated, there is the potential for airflow around the tracheostomy tube to allow for voicing.  Unfenestrated tracheostomy tubes can also be cuffed or uncuffed.  The tracheostomy tube does NOT need to be fenestrated prior to speaking valve use or capping.

fenestrated vs unfenestrated

How can you tell if a tracheostomy tube is fenestrated or unfenestrated?

The flange of the tracheostomy tube is the part that maintains contact with the person’s neck. 

The flange has important information about the type of tracheostomy tube.  The flange would indicate if the tracheostomy tube is fenestrated. 



  • Shiley fenestrated  disposable inner cannula tracheostomy tubes: DFEN
  • Shiley fenestrated cuffless tracheostomy tubes: CFEN