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What do we have to know about the patient’s tracheostomy tube?

George Barnes, MS, CCC-SLP

May 15, 2024

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Question

What do we have to know about the patient’s tracheostomy tube?

Answer

The width, length, type, and shape of a tracheostomy tube may mean the difference between a tube that easily allows airflow through and around it and one that is impenetrable from any attempts at upper airflow (Epstein, 2005). When we deflate the cuff while a patient is on the ventilator, the most important thing we are evaluating is whether or not the patient can breathe over the tube and out through the nose and mouth. We don’t want the tube to be too small or the patient may have difficulty obtaining access to adequate volumes from the ventilator, but when off the ventilator, smaller is typically better. Ideally, when the patient is “liberated” from the ventilator and they no longer need it to breathe, the patient should be considered for a tracheostomy tube “downsize” and/or to a “cuffless” tracheostomy tube. A downsize simply means a smaller tube (e.g., a #8 to a #6) and a cuffless tube no longer has the cuff used to block air to the upper airway to increase the efficiency of ventilation to the lungs. A cuffless tracheostomy tube is sometimes all you need to achieve adequate upper airflow because the cuff, even when deflated, takes up a substantial amount of space in the trachea. Other times you may need a downsize. Other times you may need a fenestrated tube (with windows) to allow even more airflow through the tracheal space. All of these options have costs and benefits that will need to be considered with IDT.

This Ask the Expert is an excerpt from the course 20Q: Beyond the Swallow - Tracheostomy Tube and Ventilator Management presented by George Barnes, MS, CCC-SLP.


george barnes

George Barnes, MS, CCC-SLP

George Barnes MS, CCC-SLP, BCS-S is a Board Certified Specialist in swallowing and swallowing disorders and has developed an expertise in dysphagia management focusing on diagnostics and clinical decision-making in the medically complex population. George yearns to make education useful and quality care accessible. With a passion for food and a deep appreciation for the joy and connection it brings to our lives, he has dedicated his life to helping others enjoy this simple, but deep-rooted pleasure.


Related Courses

20Q: Beyond the Swallow - Tracheostomy Tube and Ventilator Management
Presented by George Barnes, MS, CCC-SLP
Text

Presenter

George Barnes, MS, CCC-SLP
Course: #10056Level: Intermediate1 Hour
  'It was a great summary and overview for adult consideration'   Read Reviews
This course addresses the various questions that may arise for the medical SLP involved in the care of patients with tracheostomy and/or mechanical ventilation. Topics include causes of respiratory failure, consequences of tracheostomy/ventilation, risk management related to intervention, and considerations for assessment and treatment of swallowing and communication, including the use of speaking valves.

Eating Again After Extubation: A Case Study
Presented by George Barnes, MS, CCC-SLP
Video

Presenter

George Barnes, MS, CCC-SLP
Course: #10582Level: Intermediate1 Hour
  'Identification of risk factors that may increase risk of dysphagia after extubation in addition to learning through the case study'   Read Reviews
Key factors related to respiratory failure and oral intubation, including levels of respiratory support and effects of intubation on the larynx and swallow, are reviewed in this course. A decision-making framework for creating evidence-based, individualized plans of care is described within the context of a case study.

Eating Again After Trach/Vent: A Case Study
Presented by George Barnes, MS, CCC-SLP
Video

Presenter

George Barnes, MS, CCC-SLP
Course: #10638Level: Intermediate1 Hour
  'SORRY!!! THIS ONE WAS THE MEAT AND POTATOES!!!'   Read Reviews
The research and theoretical framework behind trach/vent management, including elements of decision-making and risk assessment and management, are described in this course. A complex case study of resuming oral intake in a patient with trach/vent is presented to provide an in-depth look at real-world application of this information.

Breathe, Speak, Eat: What the SLP Needs to Know About Respiratory Failure
Presented by George Barnes, MS, CCC-SLP
Video

Presenter

George Barnes, MS, CCC-SLP
Course: #10445Level: Introductory1 Hour
  'George was an excellent presenter, breaking down information well in the beginning to assist in comprehension during the remaining lecture'   Read Reviews
This is Part 1 of a two-part series. Respiratory disease, respiratory failure, oral intubation, effects of intubation on the larynx and the swallow, and dysphagia management are discussed in this course. Risk factors and salient features of dysphagia after extubation are described in order to help clinicians effectively evaluate and treat their patients.

Breathe, Speak, Eat: What the SLP Needs to Know About Trachs and Vents
Presented by George Barnes, MS, CCC-SLP
Video

Presenter

George Barnes, MS, CCC-SLP
Course: #10461Level: Introductory1 Hour
  'The presentation was detailed and easy to follow'   Read Reviews
This is Part 2 of a two-part series. An overview of tracheostomy tube and mechanical ventilator management, including their effects on airflow, speech and swallowing, is provided in this course. Discussion includes speaking valves, common challenges, and ways to improve outcomes in this complex patient population.

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