Tracheostomy tube

Last revised by Dr Daniel J Bell on 20 Jun 2022

Tracheostomy tubes, a.k.a. tracheotomy tubes, are inserted through a stoma post-tracheostomy to help patients unable to breathe normally. It may be temporary or permanent depending on the patient's condition, with its insertion where clinically indicated showing a lowered in-hospital mortality rate 1. To enable verbal communication, variations of the tube include:

  • electrolarynx
  • fenestrated tracheostomy tube
  • talking tracheostomy tube
  • speaking valve (e.g. Passy Muir valve)

Unlike endotracheal tubes, there are currently no universally accepted imaging guidelines on determining the correct tracheostomy tube placement for adult patients. Some suggestions have included the tube tip being located at:

  • the midpoint between the upper end of the tube (i.e. insertion point) and the carina
  • the level of the clavicles

NB Clinical decisions regarding tracheostomy tube size and position should not be based on a chest x-ray 3,4; direct tracheoscopy measurement is still recommended 3.

  • bleeding
  • damage to esophagus
  • mucus and fluid build-up, leading to breathing difficulties and infection

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Cases and figures

  • Case 1: trachestomy tube in situ
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  • Case 2: tracheostomy tube in situ
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  • Case 3: Passy Muir speaking valve
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