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Tube types
- Bivona (silicone) vs Shiley (plastic)
- typically using Bivona in pediatrics
- Cuff vs no cuff
- cuff for risk of aspiration; no cuff if patient is getting better and doesnt need PPV
- advantage: gives better PIP, PEEP
- disadvantage: can’t talk, taste, smell
- Air vs TTS
- FlexTend option
- one of the favorites in peds on babies with no necks for example (flexible and can move around)
- Custom
- can get custom length/diameter to fit patient
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HME - heated moisture exchanger (allows patient to maintain their own humidification of air)
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Obturator - like a stylet, allows rigidity so you can push trach in
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Trach speaking valve
- one-way valve opens only during inspiration so you can exhale through oronasopharynx
- may need to remove if pt is hypotonic, in seizure, anything that can cause respiratory problems
- not something you can just leave on, don’t forget to deflate the cuff!
- can’t use if pt is feeding by mouth (weird sensation on esophagus)
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Tracheostomy caddy in pt room
- tells you if upper airway is continuous or discontinuous (for ex craniofacial anomalies)
- tells you what size tube to use
- tells you what to do if they need backup or intubation
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Complications
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Trach caregiver training checklist
- Two (ideally three) caregivers
- CPR
- Emergency scenario teaching and review
- 3 trach changes per caregiver
- wait until stoma has matured
