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Tracheostomy tubes

Up Blocked tracheostomy Ciaglia technique Tracheostomy tubes


  • single or double lumen
  • curved or angled
  • variable length
    • extra proximal length (useful for obese patients)

      © Janet Fong, July 2008
      Normal length

      © Janet Fong, July 2008
      Extra proximal length
    • extra distal length (useful for patients with tracheal abnormalities)
  • fixed or adjustable flange
  • ± reinforced (NB not MRI compatible)
  • uncuffed or cuffed
    • high volume low pressure cuff (most common)
    • low volume high pressure
    • foam cuffs
      • may be useful for patients with tracheomalacia
  • sizing
    • ISO standard sizes based on the internal diameter of tube
    • Jackson sizes - used for Shiley tubes
      Size Inner diameter with inner tube (mm) Inner diameter without inner tube (mm) Outer diameter (mm)
      4 5 6.7 9.4
      6 6.4 8.1 8.1
      8 7.6 9.1 12.2
      10 8.9 10.7 13.8

Single lumen

  • cuffed or uncuffed
  • cuffed single lumen tubes are suitable for ventilation of patients who are entirely ventilator-dependent
  • variations include
    • tubes with the facility for subglottic aspiration of secretions or vocalization
    • foam cuff tubes
    • adjustable flange tubes
      • may be useful in patients with unusual anatomy of neck, particularly when the depth of the trachea is such that the fixed curvature of a standard tracheostomy tube is unsuitable (eg obese patients)

©Janet Fong, June 2008

Single lumen, cuffed, angled PVC tracheostomy tube

Double lumen

  • these have an inner tube which can be removed and cleaned thus reducing the chance of blockage and facilitating management of tube obstruction

    ©Janet Fong, June 2008
    • note that obstruction at the tip of the tube may not be relieved by removal of the inner tube

©Janet Fong, June 2008

  • generally not suitable for patients who are entirely ventilator dependent as inner tube may inadvertently slip out
  • work of breathing may be increased as the internal diameter is lower relative to the external diameter than for single lumen tubes
  • double lumen tubes may be fenestrated or unfenestrated and cuffed or uncuffed
    • fenestrated tubes have an opening in the tube between the external orifice and the cuff which allows gas to pass up to and down from the larynx. Use of an unfenestrated inner tube closes the opening while use of a fenestrated inner tube opens the passage

©Janet Fong, June 2008

Fenestrated cuffed curved double lumen tube with unfenestrated inner tube

©Janet Fong, June 2008

Fenestrated cuffed curved double lumen tube with fenestrated inner tube and external orifice occluded

  • generally the fenestrated inner tube is used with the cuff of the tube deflated and the external orifice of the tube occluded. This allows the patient to breath through his/her mouth and allows true coughing, as opposed to huffing
  • the unfenestrated inner tube should be used when tracheal suction is performed to ensure that the suction catheter does not pass out through the fenestration and impinge on the tracheal wall

Suction catheter passing out of fenestration in inner tube ©Janet Fong, June 2008


©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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