Cuffed Tracheostomy Tube

Definition
A cuffed tracheostomy has a balloon around the distal end of the cannula. The balloon forms a seal between the tracheostomy tube and the trachea when the cuff is inflated.

Used to:

• Prevent an air leak around the trach tube when the child is connected to positive pressure ventilation
• Reduces aspiration of secretions from the upper airway

All cuffed tracheostomy tubes have similar parts including:

• Cuffed-soft plastic balloon around the outside of the lower end of the cannula
• Cuff inflation line - very small tubing that connects the cuff internally and the pilot balloon externally to provide a way to inflate and deflate the trach tube cuff
• Pilot balloon –small external balloon that shows if the cuff is inflated or deflated 
  • does not show how much air is in the cuff
  • Do not squeeze the pilot balloon, as that will increase the pressure on the child's airway
• Valve – a spring loaded one way valve used to put air into or pull air out of the cuff using a syringe
  • Push the syringe straight in and out
  • Twisting the syringe into the valve will break it

Air cuffed tube - high volume, low pressure

Cylinder shaped plastic softens at body temperature Inflates with air Molds to walls of the trachea Distributes the pressure on the trachea more evenly Volume of air expands the trach cuff which exerts a lower pressure on the airway Cuff increases the diameter of the tracheostomy tube Can help seal the airway with minimal inflation Extra bulk can cause irritation to the stoma when changing the tube Extra bulk can make it more difficult to change the trach tube, as the tube may fit more tightly in the airway. May interfere with ability to speak even when the trach cuff is deflated

Tight-to shaft tube - high pressure, low volume

Air permeable plastic Inflates with sterile water Small increase in volume puts higher pressure on the trachea Increased pressure may cause stenosis Usually used for children requiring ventilation during sleep only, to limit the high pressure contact between the trach cuff and the airway Retracts very close to the tube when deflated No increase in tracheostomy tube diameter when deflated Usually easier to change than a standard cuffed trach tube Facilitates better phonation

Foam cuffed tube - high volume, low pressure

Cuff filled with sponge-like foam Self inflates - equalizes cuff pressure with atmospheric pressure Conforms to the contour of the trachea - helpful for tracheal malacia Cuff remains inflated at all times, but exerts less pressure on the trachea May be more difficult to deflate the cuff May be more difficult to change the trach tube

• Complications resulting from excessive pressure on the tracheal wall include:
  • Ischemic necrosis leading to stenosis
  • Ulceration and softening of the cartilage leading to tracheomalacia and dilation
  • Tracheal rupture, perforation, scarring or fistula 
• The volume of air or water to instill into the cuff will be ordered by the physician
• Do not exceed the ordered volume
• With the cuff inflated, the only route of effective air exchange is through the tracheostomy tube because air will not be able to flow freely past the exterior wall of the trach tube
• A speaking valve cannot be used with an inflated cuffed tracheostomy tube