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Electronic Letters to:

Respiration And The Airway:
R. Rajendram and N. McGuire
Repositioning a displaced tracheostomy tube with an Aintree intubation catheter mounted on a fibre-optic bronchoscope
Br. J. Anaesth. 2006; 97: 576-579 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read E-letter] Adjustable flange tracheostomy devices
Adrian P Jennings   (13 October 2006)

Adjustable flange tracheostomy devices 13 October 2006
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Adrian P Jennings,
SHO Anaesthesia
Horton General Hospital, Banbury, Oxon OX16 9AL

Send letter to journal:
Re: Adjustable flange tracheostomy devices

Editor – the description of the repositioning of a displaced tracheostomy tube by Rajendram and McGuire illustrates the difficulty in establishing a robust airway in ventilated obese patients. The distance between the skin and the trachea is too great to be safely bridged by a standard tracheostomy tube. The Bivona mid-range aire-cuff adjustable neck flange tracheostomy tube used in the case has a flexible wire-reinforced silicone shaft and is similar to a foreshortened reinforced endotracheal tube. However, the flange which secures the tube at the desired position can slip and allow the tube to become displaced causing loss of the airway or mainstem ventilation. Other techniques reported include inserting an endotracheal through a tracheostomy stoma and securing it with the flange of an adjustable flange tracheostomy tube [1]. Tube displacement is only apparent if the centimetre markings are recorded. However, this is not completely reliable as neck thickness may change, for example with oedema. Indeed, fixed length tubes may also become too long or short. Placement should therefore be checked either endoscopically or radiologically.

It is intended that adjustable flange tracheostomy devices be for temporary use until a proper length fixed neck flange tube can be obtained. Some companies will assemble a customized tracheostomy to exactly fit a patient’s needs although this takes several days. However, tracheostomy tube changes within 10-14 days are high risk procedures as the stoma tract is not established. With the prevalence of obesity increasing, there is a case for critical care units to routinely stock a range of tracheostomy sizes so that a fixed length tube can be inserted immediately avoiding the risks of an adjustable neck flange.

1. Pothier DD. Using An Endotracheal Tube Combined With An Adjustable Flange As A Longer Tracheostomy Tube. The Internet Journal of Otorhinolaryngology. 2006. Volume 4 Number 2. http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijorl/front.xml (accessed 15 August 2006)

Conflict of Interest:

None declared