2. The Blom Tracheostomy Tube
● The Blom Tracheostomy Tube System is
intended to provide tracheal access for
airway management of adult
tracheostomized patients.
● Benefits
○ Airway protection
○ Subglottic suctioning
○ Communication
4. The Blom Fenestrated Cuffed
Tracheostomy Tube
● Modified fenestrated outer cannula
○ Fenestration is located approximately 1mm from cuff
○ Cuff inflation prevents fenestration contact with the
tracheal mucosa
○ Rounded, smooth edges of fenestration helps prevent
granulations
5. Neck Plate
● Imprinted:
○ Manufacturer or
product name
○ Size
○ Inner Diameter (ID) &
Outer Diameter (OD)
of cannula
6. Unique Telephone Jack Clip Feature
● Secures inner cannula to the outer cannula
● Distinct “click” to ensure cannula is locked in
place
● Minimal effort to secure the cannula
7. Current Methods of Securing Inner
Cannula
● Requires a quarter-turn of a screw
mechanism
● Difficult to connect and disconnect inner
cannulas
○ Patient discomfort is a common complaint
9. Blom Subglottic Suctioning Cannula
● Provides secretion management for trach patients
● Small suction line on the outer surface of the inner
cannula
● Suction line terminates at the lower portion of the
fenestration, directly above the cuff
Current subglottic suctioning tubes:
●
●
●
●
Suction line is on the exterior of the outer cannula
Difficult and uncomfortable for patient
Blockage requires complete change of
tracheostomy tube
Flush while still in airway is not an approved
practice by some manufacturers
10. Blom Subglottic Suctioning Cannula
● Continuous low suction
● Suction on high flow applied
intermittently using a suction
regulator capable of intermittent,
timed on/off cycles.
● Can be attached to an air source to
verify the upper airway patency of
patient prior to use of speech
cannula
11. Blom Speech Cannula
● Used only with Blom Fenestrated
Cuffed Tracheostomy Tube
● Intended for respirator dependent
patients
● No cuff deflation required
○ Diminished risk of aspiration
● Bubble Valve near fenestration
● Flap Valve at lower end of inner
cannula tube
12. How it Works
● Inhalation
○ Bubble Valve expands and Flap Valve opens
○ Air delivered to lungs
● Exhalation
○ Flap Valve closes and Bubble Valve collapses
○ Air goes through fenestration to vocal cords
○ Phonation
13. Recap of Speech Cannula
Benefits
● Decreased risk of aspiration since cuff remains inflated
● Vocalization takes place during exhalation
○ More natural speech
● Allows patients who cannot tolerate cuff deflation the
ability to vocalize
● Helps to maintain subglottic pressure
○ May assist in swallowing and secretion management
14. Exhaled Volume Reservoir (EVR)
● Prevents the occurrence of “false” low
expiratory minute volume alarms which
occur when the Blom Speech Cannula is in
use and air is redirected through the upper
airway during exhalation (vs back to
ventilator)
● Compatible with most positive pressure
ventilators
15. Blom Low Profile Valve (LPV)
● Speaking Valve
● Use with Blom Non-Fenestrated Uncuffed
or Fenestrated Cuffed tubes
● One-way valve
● Fits in outer cannula
● For non-ventilator dependent patients
● Cuff may be inflated, partially deflated, or
fully deflated
○ Does NOT require cuff deflation
● Low profile
16. Current Speaking Valves
● Typically used with deflated cuff
● High profile
● Risk of cardiopulmonary complications if
used inappropriately
17. Limitations
● The LPV does not have a standard 15mm
hub connector and therefore will not attach
to a manual resuscitator or a ventilator circuit
● A Standard or Subglottic Suctioning Cannula
of correct size should be readily available in
case the use of a 15mm connector is
needed
18. The Blom Trach Candidate
● Arousable with the potential to communicate
● May be in volume or pressure ventilation in any
ventilatory mode
● Does not need to be breathing spontaneously
● Does not need to be able to tolerate cuff deflation
● The patient should not have copious, thick secretions
requiring suctioning more than five times per hour
● The patient should have a patent, unobstructed upper
airway
● FiO₂should not exceed 60% & PEEP should not exceed
10
19. Blom Series: Sizes & Components
● 2 Series of Blom Tubes
○ Rigid type material (like Shiley)
○ Soft type material (like Portex)
● Standard Cannula
● Subglottic Suctioning Cannula
● Speech Cannula
● LPV
● EVR
● Decannulation Plug
● SoftTouch Tube Holder
Sizes
ID
(mm)
OD
(mm)
Length
(mm)
4
5.0
9.4
62
6
6.4
10.8
74
8
7.6
12.2
79
10
8.9
13.8
79
20. Closing Thoughts
The Blom is not a specialty or custom tracheostomy tube and can be used as the initial tracheostomy tube. However, at this time
the patient is most likely to be admitted to a hospital with a different tracheostomy tube such as a Shiley, Portex or Bivona. These
are more common tracheostomy tubes at this time. Therefore, the entire tracheostomy tube must be changed to the Blom
Tracheostomy Tube, to use the Blom Valve Speech Cannula or the Low Profile Valve. This is may be more difficult to do, and
more costly than the Passy-Muir Speaking Valve. The PMV can fit onto the hub of all Shiley, Portex, Jackson metal, and Bivona
(unable to use with foam filled Bivona). It seems that the PMV should be trialed first if the patient was admitted with a
tracheostomy tube other than the Blom, if the cuff is able to be deflated.
However, the Blom Tracheostomy Tube system is another device that can be utilized in acute or long term care to help improve
our patient’s communication. Patients on mechanical ventilation who are unable to tolerate cuff deflation are ideal candidates for
the Blom Tracheostomy Tube to allow for speech. This may include patients with ALS, cervical spine injury, and progressive
neurological disorders. The Blom Tracheostomy Tube system has shown to be safe and effective and well tolerated in individuals
with mechanical ventilation (Kunduk, M. et. al, 2010).
References:
Kunduk, M., Appel, K. Tunc, M., Alanoglu, Z., Alkis, N.Dursun, G., & Ozgursoy, O.B. Preliminary report of laryngeal phonation
during mechanical ventilation via a new cuffed tracheostomy tube. Respiratory Care. 55(12) 1661-90.
