How to use a tracheostomy tube with an inner cannula?
1. Why should we use a tracheostomy tube with an inner cannula?
During the indwelling of the tracheal intubation, airway secretions will accumulate in the lumen of the tracheal intubation and severely reduce the diameter of the lumen, which will increase the work of breathing and block the patient's airway. To ensure that this does not happen, we need to replace the tracheostomy tube frequently. However, in practice, it is believed that the best time to replace the tracheostomy tube without an inner cannula is every 7 to 14 days. Frequent replacement of the tracheostomy tube will make the patient feel uncomfortable and cause damage to the tracheostomy fistula. The use of a tracheostomy tube with an inner cannula can reduce this risk because:
The tracheostomy tube can be kept in place for up to 30 days;
The inner cannula can be replaced frequently to reduce the risk of blockage;
Regular cleaning or replacing the inner cannula will minimize the risk of infection.
2. What should we pay attention to when choosing the model (size) of the tracheostomy tube with the inner cannula?
● Please note that the tracheostomy tube with the inner cannula will reduce the internal diameter by 1-1.5mm. It increases the work done by the patient while breathing.
● The increased airway resistance of a catheter with an inner diameter of less than 7.0mm will significantly increase the patient's work breathing. We should avoid it as much as possible.
● Be careful to use the correct diameter and length when replacing the inner cannula. If the larger inner cannula is forced into the tracheostomy tube, it will protrude from the tip of the tracheostomy tube because it is too long. It can cause damage to the soft tracheal mucosa. If the inner cannula is too tiny, secretions can accumulate in the space between the outer tube and the inner cannula.
3. How to apply the tracheostomy tube kits with the inner cannula with or without the hole in the clinic?
The perforated tracheostomy cannula allows the patients to breathe directly through their mouth or nasopharyngeal cavity (oral cavity, nasal cavity, and vocal cords) as if passing through a fistula. It helps the patient to return to normal breathing. However, the contents of the mouth or stomach may also enter the lungs through the holes. Patients at risk of inhalation or under IPPV (Invasive Positive Pressure Ventilation) treatment should not use a tracheostomy tube with the hole unless they use an inner cannula without the hole to close the hole meanwhile.
The perforated tracheostomy cannula could assist the patient in detaching from the temporary tracheostomy tube. The patients could remove the inner tube (if there is no hole and the balloon has deflated) to reduce the work required for breathing. In this way, the patient can breathe through the hole of the tracheostomy cannula.
4. How to insert or remove the inner cannula of the tracheostomy tube?
When inserting the inner cannula, fix the tracheostomy outer tube with gloved fingers first, and then insert the inner tube forward and upward. Confirm that the inner sleeve is fully locked.
When removing the inner cannula, fix the outer tube first, pull the small ring at the end of the inner cannula, and then pull the inner cannula outwards and downwards gently.
If there are no apparent secretions or bending in the inner cannula, please insert it back. We can flush the loose secretions with a syringe with 0.9% saline. Be careful not to contaminate the inner cannula. If the inner cannula is damaged or partially blocked by dry secretions, please discard it.
5. Methods of cleaning and disinfecting the inner cannula
The inner cannula should be cleaned and disinfected every 12 hours. To prevent the inner cannula from clogging, use a brush, 3% hydrogen peroxide solution, and clean and disinfect following the tracheostomy cannula disinfection process.
QA Medical's PUREWAY series of tracheostomy products meet the clinical needs of different patients depending on the age, size, and treatment process. It covers conventional products, special categories, and products used in emergencies, providing the best artificial airway management solutions.
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