The document discusses tracheostomy tube options for patients at a ventilator unit. It notes there are many different tube styles, sizes, materials and designs to meet diverse patient needs. The three most commonly used tubes are the Shiley DCT, Portex DIC, and Bivona TTS, though special order tubes are also used. Tube selection requires considering each patient's diagnoses, prognosis and treatment goals to facilitate recovery while avoiding complications. Maintaining a variety of tube options is important to provide appropriate care for each individual patient.
This short document promotes creating presentations using Haiku Deck, a tool for making slideshows. It encourages the reader to get started making their own Haiku Deck presentation and sharing it on SlideShare. In just one sentence, it pitches the idea of using Haiku Deck to easily create engaging slideshows.
Holiday Rejects is Canada's first ugly Christmas sweater store, founded by Kyle Fitzgerald, Adil Hooda, Chris Cheung, and Jack Hsu. It operates pop-up stores and kiosks across Canada during the holiday season, selling vintage and new ugly sweaters. While the founders share equal responsibility, Adil Hooda seems to be the driving force behind the business idea and its leadership. Through its niche product and trendy concept, Holiday Rejects has found success, but will need to expand carefully to maintain growth and avoid threats in the competitive retail market.
Professor Kendall recalls his memories of meeting and getting to know Alfred Rényi, the interviewer's father, through various mathematical conferences in the 1950s-1960s. He first saw Rényi give a lecture in 1954 but did not meet him. They became acquainted in 1963 in Tbilisi and soon became friends. In 1964, Rényi visited Kendall's college in Cambridge and they collaborated. Kendall visited Rényi's family in Budapest and they toured the city together. Kendall continued meeting Rényi at conferences in the following years and commemorated him after his death. The interviewer notes they also visited Kendall's family regularly in Cambridge in later years.
The document summarizes information about NHSMUN 2015, which will take place from March 4-7 in New York City. It is organized by IMUNA and includes the names and positions of the conference leadership. It also includes two letters from the Assistant Directors of the UNESCO committee, which introduce themselves and provide an overview of the two topics to be debated: Protecting Journalists and Preserving Syrian Culture. The letters encourage delegates to engage in productive debate and contact the directors with any questions.
El documento define el sexting como el envío de contenidos pornográficos a través de teléfonos móviles, explica que comenzó a través de SMS de naturaleza sexual, y señala que es una práctica común entre jóvenes y adolescentes a pesar de los riesgos asociados con compartir este tipo de contenido.
Today’s technology-infused classroom seeks to redefine thinking and learning. What does this look like for our learners? Explore how consumption and creation tools can be leveraged to maximize student achievement, differentiate instruction, and personalize learning in an analytics-led classroom. Empower students to be the #Boss of their learning.
This document summarizes a study that investigated the relationship between EFL learners' use of listening strategies (cognitive, metacognitive, and social/affective) and their individual differences. 40 Iranian university students completed questionnaires on strategy use, learning style, motivation, and personality traits, as well as an IELTS listening test. Statistical analysis found a significant relationship between motivation level and strategy use, and learning style also impacted strategy use. Personality traits and other variables did not significantly affect strategy use. Social/affective strategies were rarely used and omitted from analysis. The study aimed to clarify the under-researched relationship between listening strategies and individual learner differences.
This short document promotes creating presentations using Haiku Deck, a tool for making slideshows. It encourages the reader to get started making their own Haiku Deck presentation and sharing it on SlideShare. In just one sentence, it pitches the idea of using Haiku Deck to easily create engaging slideshows.
Holiday Rejects is Canada's first ugly Christmas sweater store, founded by Kyle Fitzgerald, Adil Hooda, Chris Cheung, and Jack Hsu. It operates pop-up stores and kiosks across Canada during the holiday season, selling vintage and new ugly sweaters. While the founders share equal responsibility, Adil Hooda seems to be the driving force behind the business idea and its leadership. Through its niche product and trendy concept, Holiday Rejects has found success, but will need to expand carefully to maintain growth and avoid threats in the competitive retail market.
Professor Kendall recalls his memories of meeting and getting to know Alfred Rényi, the interviewer's father, through various mathematical conferences in the 1950s-1960s. He first saw Rényi give a lecture in 1954 but did not meet him. They became acquainted in 1963 in Tbilisi and soon became friends. In 1964, Rényi visited Kendall's college in Cambridge and they collaborated. Kendall visited Rényi's family in Budapest and they toured the city together. Kendall continued meeting Rényi at conferences in the following years and commemorated him after his death. The interviewer notes they also visited Kendall's family regularly in Cambridge in later years.
The document summarizes information about NHSMUN 2015, which will take place from March 4-7 in New York City. It is organized by IMUNA and includes the names and positions of the conference leadership. It also includes two letters from the Assistant Directors of the UNESCO committee, which introduce themselves and provide an overview of the two topics to be debated: Protecting Journalists and Preserving Syrian Culture. The letters encourage delegates to engage in productive debate and contact the directors with any questions.
El documento define el sexting como el envío de contenidos pornográficos a través de teléfonos móviles, explica que comenzó a través de SMS de naturaleza sexual, y señala que es una práctica común entre jóvenes y adolescentes a pesar de los riesgos asociados con compartir este tipo de contenido.
Today’s technology-infused classroom seeks to redefine thinking and learning. What does this look like for our learners? Explore how consumption and creation tools can be leveraged to maximize student achievement, differentiate instruction, and personalize learning in an analytics-led classroom. Empower students to be the #Boss of their learning.
This document summarizes a study that investigated the relationship between EFL learners' use of listening strategies (cognitive, metacognitive, and social/affective) and their individual differences. 40 Iranian university students completed questionnaires on strategy use, learning style, motivation, and personality traits, as well as an IELTS listening test. Statistical analysis found a significant relationship between motivation level and strategy use, and learning style also impacted strategy use. Personality traits and other variables did not significantly affect strategy use. Social/affective strategies were rarely used and omitted from analysis. The study aimed to clarify the under-researched relationship between listening strategies and individual learner differences.
Poppy joined Jung school where his teacher was Choa Jung. He received two first place medals for being brave and good. Poppy went ice skating and found it difficult at first but then realized it was easy. Poppy took daily piano lessons from Miss Choa Jung and learned to play the instrument. Poppy picked fruit from a tree, sat in an apple tree and ate an apple. The narrator hopes Poppy had fun during his visit and will return as they will miss him after their great time together.
Majeed Kunju Subair is seeking a position in construction and maintenance with over 10 years of experience. He has skills in computerized maintenance management systems, document management, and SAP/ERP systems. His experience includes roles as an HR coordinator, document controller, secretary, and administrative assistant. He is proficient in Microsoft Office applications and seeks to contribute his skills in planning, problem-solving, and effective communication.
Este documento ofrece remedios naturales para tratar las hemorroides de forma efectiva y sin dolor. Recomienda aplicar crema de avellana en forma de compresas para aliviar la inflamación y detener el sangrado debido a sus propiedades astringentes. También sugiere consumir cápsulas, ungüentos o compresas de escorza de carnicero o ruscus aculeatus para disminuir la hinchazón, o tomar polvo de semillas de mango mezclado con miel y agua hirviendo. El objetivo es desinflamar
I worked on a research project at Lawrence Berkeley National Lab to develop ceramic scintillators for medical and security applications. I synthesized barium-based ceramic samples doped with elements like europium, measured their performance through techniques like X-ray diffraction and luminescence, and analyzed the results. The most promising sample was lanthanum barium chloride doped with 5% europium, which showed high transparency and light output. Further experiments aim to optimize europium concentration to improve scintillator characteristics.
This document appears to be analyzing trends for different generations (Generation X, Generation Y, Generation Z) for spring/summer 2015 fashion. For Generation X, it focuses on incorporating past trends with modern updates, using light colors and 1970s silhouettes. Generation Y trends are described as gentlemanly grunge with a twist of class, taking inspiration from history. Generation Z fashion is characterized as "Simply Rich", catering to the rising number of affluent millennials seeking luxury brands and defined by key must-have items. Retail stores like Anthropic are mentioned for each generation.
The document provides information about CSIA Ontario events, the professional training series, and ways for ski instructors to earn credits towards certification levels. It discusses the kick-start social event with keynote speaker Steve Young about Interski 2015 in Argentina. It also provides tips for warming up before skiing, including focusing on body awareness and scanning emotions on the first run.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help alleviate symptoms of mental illness and support overall brain health.
A 50-year-old female patient was admitted to the ICU with a spontaneous intracranial hemorrhage and underwent a tracheostomy after 7 days. After 4 days, the outer part of the tracheostomy tube became longer for no apparent reason. The patient then developed surgical emphysema, hypoxia, and arrested despite attempts at reintubation. The resident was unable to explain what happened to the tracheostomy tube.
This document provides guidance on caring for a child with a tracheostomy. It discusses reasons for tracheostomy placement including upper airway obstruction and lung disease. Proper tracheostomy tube selection and changing is important as is regular cleaning and suctioning to maintain a clear airway. Caregivers must be trained on all aspects of care before a child is discharged home.
Lung Transplant In Delhi and Gurgaon, India
A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. A lung transplant is reserved for people who have tried medications or other treatments, but their conditions haven't sufficiently improved.
Depending on the medical condition, a lung transplant may involve replacing one of your lungs or both of them. In some situations, the lungs may be transplanted along with a donor heart.
While a lung transplant is a major operation that can involve many complications, it can greatly improve your health and quality of life.
A multi-disciplinary team is essential for effective home mechanical ventilation programs. The document discusses recommendations from Dr. Chan Yeow on setting up such a program in Singapore. Key points include:
- A home ventilation program should consist of an ICU-trained nurse, a technical provider, a family physician, and a respiratory therapist as a minimum.
- Initial ventilator settings are determined based on the patient's condition and disease progression, aiming to balance adequate ventilation with encouraging compliance.
- Challenges include managing changes in patient and caregiver situations long-term and supporting end-of-life decisions.
- Home care is more cost-effective than hospitalization, with costs in Singapore being around SGD
Tracheostomy is a surgical procedure that creates an opening in the trachea to allow for an alternative airway. It is commonly performed when a patient requires prolonged intubation or has an airway obstruction. There are two main techniques for tracheostomy - open and percutaneous. Complications can include bleeding, infection, and injury to surrounding structures like the vocal cords. Tracheostomy tubes come in various shapes, sizes, and materials like PVC or silicone. Factors like the patient's anatomy and needs determine the appropriate tube type and size for safe and effective ventilation and airway management.
This document discusses techniques for performing surgical tracheostomies. It begins by providing historical context and then covers indications and timing considerations. The optimal timing remains controversial but most agree conversion from an endotracheal tube to tracheostomy is indicated after 7-10 days of intubation if the patient is not likely to be extubated soon. The document then reviews tracheostomy anatomy and techniques including standard open surgical procedure which involves making a transverse incision above the suprasternal notch, retracting muscles to expose the trachea, and creating a vertical incision between tracheal rings to insert the tracheostomy tube. Post-procedure care and complications are also briefly mentioned.
This document provides information on various types of endotracheal tubes (ETTs). It discusses the history and development of ETTs, including their physical characteristics such as material, size, length, curvature, connectors, and safety features like cuffs and murphy eyes. Specialized ETTs are also covered, including RAE tubes, laser tubes, microlaryngeal tubes, and nerve integrity monitoring tubes. The document aims to educate readers on the design and proper use of ETTs.
An educational material describing the Indications for Tracheostomy-Complications of Tracheostomy-Timing of Tracheostomy-Tracheostomy Technique-Tracheostomy Decannulation and types of Tracheostomy Tubes.
An educational material describing the Indications for Tracheostomy-Complications of Tracheostomy-Timing of Tracheostomy-Tracheostomy Technique-Tracheostomy Decannulation and types of Tracheostomy Tubes. Quite useful for general surgery residents and medical students and also general physicians.
An educational material describing the Indications for Tracheostomy-Complications of Tracheostomy-Timing of Tracheostomy-Tracheostomy Technique-Tracheostomy Decannulation and types of Tracheostomy Tubes
This document discusses airway stents, which are tube-shaped devices inserted bronchoscopically into airways to treat various large airway diseases. It describes indications for airway stenting including malignant and benign airway obstructions. The main types of stents are silicone, metal, and hybrid stents. The document reviews the techniques for inserting and monitoring airway stents as well as potential complications.
The document summarizes various evidence-based bundles developed by IHI and CDC to prevent healthcare-associated infections from central lines, ventilators, and urinary catheters. It describes the components of the central line bundle (hand hygiene, barrier precautions, chlorhexidine skin antisepsis, optimal site selection, and daily line necessity review). It also outlines the central line maintenance bundle, ventilator bundle, and urinary catheter bundle, explaining each component and its rationale.
Tube thoracostomy is a procedure to drain fluid or air from the pleural space by inserting a chest tube. It is indicated for conditions such as pneumothorax, hemothorax, and postoperative drainage. The chest tube is inserted using sterile technique between the 4th and 5th ribs in the midaxillary line and connected to a water seal drainage system. Proper patient care involves monitoring drainage, respiratory status, and ensuring the drainage system remains patent. Complications include hemorrhage, lung laceration, and tube blockage or dislodgement.
This document provides an overview of tracheostomy procedures. It discusses the history and indications for tracheostomy, including emergent situations and prolonged ventilation. The document outlines the different types of tracheostomy tubes and percutaneous versus open surgical procedures. Post-operative care and potential complications are summarized, including issues related to decannulation. The optimal timing of tracheostomy is addressed, noting it is usually performed between 7-21 days of ventilation pending patient factors.
Poppy joined Jung school where his teacher was Choa Jung. He received two first place medals for being brave and good. Poppy went ice skating and found it difficult at first but then realized it was easy. Poppy took daily piano lessons from Miss Choa Jung and learned to play the instrument. Poppy picked fruit from a tree, sat in an apple tree and ate an apple. The narrator hopes Poppy had fun during his visit and will return as they will miss him after their great time together.
Majeed Kunju Subair is seeking a position in construction and maintenance with over 10 years of experience. He has skills in computerized maintenance management systems, document management, and SAP/ERP systems. His experience includes roles as an HR coordinator, document controller, secretary, and administrative assistant. He is proficient in Microsoft Office applications and seeks to contribute his skills in planning, problem-solving, and effective communication.
Este documento ofrece remedios naturales para tratar las hemorroides de forma efectiva y sin dolor. Recomienda aplicar crema de avellana en forma de compresas para aliviar la inflamación y detener el sangrado debido a sus propiedades astringentes. También sugiere consumir cápsulas, ungüentos o compresas de escorza de carnicero o ruscus aculeatus para disminuir la hinchazón, o tomar polvo de semillas de mango mezclado con miel y agua hirviendo. El objetivo es desinflamar
I worked on a research project at Lawrence Berkeley National Lab to develop ceramic scintillators for medical and security applications. I synthesized barium-based ceramic samples doped with elements like europium, measured their performance through techniques like X-ray diffraction and luminescence, and analyzed the results. The most promising sample was lanthanum barium chloride doped with 5% europium, which showed high transparency and light output. Further experiments aim to optimize europium concentration to improve scintillator characteristics.
This document appears to be analyzing trends for different generations (Generation X, Generation Y, Generation Z) for spring/summer 2015 fashion. For Generation X, it focuses on incorporating past trends with modern updates, using light colors and 1970s silhouettes. Generation Y trends are described as gentlemanly grunge with a twist of class, taking inspiration from history. Generation Z fashion is characterized as "Simply Rich", catering to the rising number of affluent millennials seeking luxury brands and defined by key must-have items. Retail stores like Anthropic are mentioned for each generation.
The document provides information about CSIA Ontario events, the professional training series, and ways for ski instructors to earn credits towards certification levels. It discusses the kick-start social event with keynote speaker Steve Young about Interski 2015 in Argentina. It also provides tips for warming up before skiing, including focusing on body awareness and scanning emotions on the first run.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help alleviate symptoms of mental illness and support overall brain health.
A 50-year-old female patient was admitted to the ICU with a spontaneous intracranial hemorrhage and underwent a tracheostomy after 7 days. After 4 days, the outer part of the tracheostomy tube became longer for no apparent reason. The patient then developed surgical emphysema, hypoxia, and arrested despite attempts at reintubation. The resident was unable to explain what happened to the tracheostomy tube.
This document provides guidance on caring for a child with a tracheostomy. It discusses reasons for tracheostomy placement including upper airway obstruction and lung disease. Proper tracheostomy tube selection and changing is important as is regular cleaning and suctioning to maintain a clear airway. Caregivers must be trained on all aspects of care before a child is discharged home.
Lung Transplant In Delhi and Gurgaon, India
A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. A lung transplant is reserved for people who have tried medications or other treatments, but their conditions haven't sufficiently improved.
Depending on the medical condition, a lung transplant may involve replacing one of your lungs or both of them. In some situations, the lungs may be transplanted along with a donor heart.
While a lung transplant is a major operation that can involve many complications, it can greatly improve your health and quality of life.
A multi-disciplinary team is essential for effective home mechanical ventilation programs. The document discusses recommendations from Dr. Chan Yeow on setting up such a program in Singapore. Key points include:
- A home ventilation program should consist of an ICU-trained nurse, a technical provider, a family physician, and a respiratory therapist as a minimum.
- Initial ventilator settings are determined based on the patient's condition and disease progression, aiming to balance adequate ventilation with encouraging compliance.
- Challenges include managing changes in patient and caregiver situations long-term and supporting end-of-life decisions.
- Home care is more cost-effective than hospitalization, with costs in Singapore being around SGD
Tracheostomy is a surgical procedure that creates an opening in the trachea to allow for an alternative airway. It is commonly performed when a patient requires prolonged intubation or has an airway obstruction. There are two main techniques for tracheostomy - open and percutaneous. Complications can include bleeding, infection, and injury to surrounding structures like the vocal cords. Tracheostomy tubes come in various shapes, sizes, and materials like PVC or silicone. Factors like the patient's anatomy and needs determine the appropriate tube type and size for safe and effective ventilation and airway management.
This document discusses techniques for performing surgical tracheostomies. It begins by providing historical context and then covers indications and timing considerations. The optimal timing remains controversial but most agree conversion from an endotracheal tube to tracheostomy is indicated after 7-10 days of intubation if the patient is not likely to be extubated soon. The document then reviews tracheostomy anatomy and techniques including standard open surgical procedure which involves making a transverse incision above the suprasternal notch, retracting muscles to expose the trachea, and creating a vertical incision between tracheal rings to insert the tracheostomy tube. Post-procedure care and complications are also briefly mentioned.
This document provides information on various types of endotracheal tubes (ETTs). It discusses the history and development of ETTs, including their physical characteristics such as material, size, length, curvature, connectors, and safety features like cuffs and murphy eyes. Specialized ETTs are also covered, including RAE tubes, laser tubes, microlaryngeal tubes, and nerve integrity monitoring tubes. The document aims to educate readers on the design and proper use of ETTs.
An educational material describing the Indications for Tracheostomy-Complications of Tracheostomy-Timing of Tracheostomy-Tracheostomy Technique-Tracheostomy Decannulation and types of Tracheostomy Tubes.
An educational material describing the Indications for Tracheostomy-Complications of Tracheostomy-Timing of Tracheostomy-Tracheostomy Technique-Tracheostomy Decannulation and types of Tracheostomy Tubes. Quite useful for general surgery residents and medical students and also general physicians.
An educational material describing the Indications for Tracheostomy-Complications of Tracheostomy-Timing of Tracheostomy-Tracheostomy Technique-Tracheostomy Decannulation and types of Tracheostomy Tubes
This document discusses airway stents, which are tube-shaped devices inserted bronchoscopically into airways to treat various large airway diseases. It describes indications for airway stenting including malignant and benign airway obstructions. The main types of stents are silicone, metal, and hybrid stents. The document reviews the techniques for inserting and monitoring airway stents as well as potential complications.
The document summarizes various evidence-based bundles developed by IHI and CDC to prevent healthcare-associated infections from central lines, ventilators, and urinary catheters. It describes the components of the central line bundle (hand hygiene, barrier precautions, chlorhexidine skin antisepsis, optimal site selection, and daily line necessity review). It also outlines the central line maintenance bundle, ventilator bundle, and urinary catheter bundle, explaining each component and its rationale.
Tube thoracostomy is a procedure to drain fluid or air from the pleural space by inserting a chest tube. It is indicated for conditions such as pneumothorax, hemothorax, and postoperative drainage. The chest tube is inserted using sterile technique between the 4th and 5th ribs in the midaxillary line and connected to a water seal drainage system. Proper patient care involves monitoring drainage, respiratory status, and ensuring the drainage system remains patent. Complications include hemorrhage, lung laceration, and tube blockage or dislodgement.
This document provides an overview of tracheostomy procedures. It discusses the history and indications for tracheostomy, including emergent situations and prolonged ventilation. The document outlines the different types of tracheostomy tubes and percutaneous versus open surgical procedures. Post-operative care and potential complications are summarized, including issues related to decannulation. The optimal timing of tracheostomy is addressed, noting it is usually performed between 7-21 days of ventilation pending patient factors.
This document provides information on best practices for basic care of indwelling urinary catheters. It discusses short-term versus long-term catheter use, types of catheters, insertion and securement, drainage bags, irrigation, symptoms of catheter-associated urinary tract infections, and prevention of CAUTIs. The document aims to educate continence nurses to improve patient care and health outcomes related to indwelling urinary catheter use globally.
Peritoneal Dialysis – Procedure and Recovery.pdfMeghaSingh194
The kidney failure treatment known as Peritoneal Dialysis (PD) is a type of dialysis. The lining of the peritoneal cavity (the abdominal cavity) serves as the membrane through which excess fluid and waste are expelled. Let's explore more: https://www.southlakegeneralsurgery.com/peritoneal-dialysis-procedure-and-recovery/
1. Tracheostomy Tubes at Coventry’s Ventilator Unit: Options and Choices
Adam J. Ross, CRT
At Coventry Skilled Nursing & Rehabilitation’s ventilator unit we utilize a plethora of
tracheostomy tubes with our patients. There are many different styles, models, designs, and sizes to
consider. Careful and comprehensive assessments must be made prior to providing a new or different
tube for a patient. The objective is to provide for our patients an apparatus that will help facilitate the
attainment of their individual long-term goals while minimizing complications.
Subacute ventilator units will see a wide variety of patients. There are long-term patients who
will spend the rest of their lives under our care. There are occasionally short-term patients who may be
able to be weaned from their breathing machine within weeks to months. Some of our patients will be
guided to a full recovery; leaving our building without any tubes at all. Some others may only be able to
partially recover and end up going home with a tracheostomy.
With such a diverse population of pathologies and prognoses it is important for the clinical care
team to have an adequate array of devices to utilize. Every make and model has slight nuances that can
make or break a patient’s progress or continued stability1, 3
. Different sizes, materials, shapes, and other
design features need to be carefully considered prior to insertion; depending on the individual’s
diagnoses, prognoses, and reason for needing a tracheostomy their ideal device can vary wildly1,3,4
.
The most common patient ventilator status we see, by a wide margin, is a chronic and non-
weanable individual. These patients have diagnoses ranging from progressive neuromuscular disorders
(ALS, e.g.) to decades old strokes that have kept them in an unresponsive persistent vegetative state
since the original incident took place. Some of our chronic ventilator patients simply have poor airway
maintenance and only utilize the breathing machine at night, but require the tube so that care providers
can suction their trachea out routinely. Some can swallow, some can speak, and some can do neither. As
we can see, even among the same subset of patients there are needs that differ greatly from one
another.
The most common tube we see upon admission is a Shiley DCT. This thick-walled, rigid tube is a
great choice for long-term ventilator or tracheostomy patients, especially if the only concern is to
provide a table and patent airway. However, the Shiley tube’s dimensions can make it difficult for a
patient to undergo speech and swallow trials5
. Its Inside Diameter (ID) to Outside Diameter (OD) ratio
produces a tube that takes up a lot of space within the patient’s airway thus restricting flow and often
preventing progression or phonation5
. Despite its drawback the tube continues to be a popular choice
for stable, long-term tracheostomy patients due to its rugged construction and ease of care.
Another popular routine tracheostomy tube we utilize and admit patients with is the Portex DIC.
Similar in shape to the aforementioned Shiley tube, the Portex has a significantly smaller OD to a given
ID. These tubes can be used to provide an airway for a patient who has been identified as potentially
progressive and some quality of life goals have been initiated. While slightly more flexible and lighter
than Shileys, Portex tubes are still considered a standard and routine appliance.
2. The third and final tube we have been utilizing regularly within the facility is the Bivona TTS. This
silicone tube is soft, comfortable, utilizes water instead of an air cuff, and has multiple benefits for many
of our patients over the standard tubes. The “Tight to Shaft” cuff allows us to provide atraumatic tube
changes as needed while permitting increased flow around the tube and out of the mouth during
periods of cuff deflation4,5
. Studies have shown that usage of the Bivona TTS has produced improved
outcomes in terms of how quickly a weanable patient can begin speaking5
. Use of this tube has also
decreased incidents of tube malposition, hemorrhage, and can even help heal ongoing stoma infections
and complications seen with typical Polyvinyl Carbonate (PVC) tube construction in some patients5,6,7
.
We have had many different types of tubes used as well. Some of our patients have required
special order tubes that require our care team to design everything from the type of material to the
length of the shaft and placement of the cuff. While we strive to standardize as much as we can, people
can have amazingly different anatomical anomalies, material sensitivities, and tolerances. Very often a
long-term patient’s needs change; having a tracheostomy tube for long periods of time changes your
anatomy slowly among other known risks and complications.
While our top three most used tubes have proven to be adequate for most of our patient
population, there will still be individuals whose needs surpass what can be taken from routine supplies.
One thing that has made Coventry’s Ventilator Unit so successful has been early recognition of an
apparatus’ insufficient or improper usage and a team effort to devise and implement a strategy to
quickly replace it with something more suitable.
Sometimes the better strategy can be as simple as doing routine tube changes less frequently to
prevent irritation or trauma. Regardless of a tube’s construction, studies show that a tracheostomy tube
can last up to 90 days before requiring replacement2
. This means that, for some patients, we are
exposing them to less chance of injury or undue discomfort by changing a perfectly fine apparatus
excessively. This is also a cost-saving idea as some of the less common tubes are much more expensive
than our standard devices; 12 tubes a year versus 4 tubes a year is a big difference for patients with
strained coverage or facility’s with a limited budget.
In conclusion it is paramount that ventilator and tracheostomy units be able to provide for their
patients the devices needed to survive, progress, and maintain their statuses. Different patients have
different needs and to try and limit tracheostomy tube availability to a few routine models is ill-advised
and will negatively impact outcomes. People come in all shapes and sizes; there is a reason
tracheostomy tubes do to.
3. References
[1] Dean L. Cuffed vs. Uncuffed Trachs: Ask the Experts
http://www.ventusers.org/edu/valnews/val_25-3jun11p4-5.pdf
[2] Backman S. et. al. Material wear of polumeric trachestomy tubes: a six-month study.
http://www.ncbi.nlm.nih.gov/pubmed/19205021
[3] Hess D. Tracheostomy Tubes and Related Appliances. April 2005, Respiratory Care Vol. 50 No. 4
[4] Kacmerack B. Tubes and Trachs A to Z: MGH Powerpoint
http://foocus.com/power-point/Trachs-A-to-Z-FOCUS.pdf
[5] McCracken J. & Leasa D. Trach tubes designed to maximize safety may increase risk to ventilated
pateints
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220018/
[6] Dean L. Changing Tracheostomy Tube Material and Utilizing Silicone Dressings Healed This Stoma – A
Case Report
http://www.mcarthurmedical.com/upload/product_file906.flex%20tc%20pad%20rt-apr%20may
%202013
[7] Iodice F. et. al. Tracheobronchial haemorrhage in patients with neuromuscular disorders
http://www.sciencedirect.com/science/article/pii/S0954611105002465