ADULT

HOMECARE
HANDBOOK
Shiley™ Tracheostomy Tube Solutions
 Read before using this What’s inside
homecare handbook This handbook provides information on how to care for your
Caution: This handbook Shiley™ trach tube. You will find tips on how to suction, change
is intended to serve as a ties, change tubes, and care for the skin around the opening in
reference guide for the use and
care of Shiley™ trachestomy your neck. Also included are basic safety tips, a problem-solving
(trach) technology from guide, and an easy-to-understand glossary of the technical
Medtronic and should not terms you may hear. For product specific information, please
replace institutional policies or review the instructions for use (IFU) that is included in each
doctors’orders. product package.
Use of these guidelines with
other trach products is not Review safety tips and notes
recommended. You should
always follow your doctor’s On page 3, and throughout this handbook, are a number of
or hospital’s directions if they safety tips and notes designed to warn about conditions that
differ from those found here. could be potentially harmful. There are other notes that warn
Warning: Shiley™ trach tubes about situations that could damage your Shiley™ trach tube. Take
are sterile if not opened, a moment to review these tips and notes before you begin your
damaged, or broken. Do not trach tube homecare.
resterilize Shiley™ trach tubes.
All Shiley™ trach tubes are
designed to be single use, for Important phone numbers
one patient, and disposable.
Doctor_________________________________________________
Note: Federal law restricts
Shiley™ trach tubes to sale by,
or on the order of, a doctor. Home care provider______________________________________
Important product
information: For detailed
instructions, specifications, Home care supplier_______________________________________
warnings, and additional
information on Shiley™ trach Emergency______________________________________________
tubes, please refer to the
instructions for use (IFU)
provided with the product.

2
 Table of contents

How the Tracheostomy Works................................................ 4

What Changes Occur
Safety Tips............................................................................. 5
Getting Ready to Go Home..................................................... 6
What You Will Need
Tips for Daily Living................................................................ 7
Humidification, Bathing, Illness, Clothing, Getting Out
What You Will Need in a Travel Kit
Suctioning.............................................................................. 8
What You Will Need
How to Suction....................................................................... 9
Changing Ties.......................................................................11
What You Will Need
How to Change Twill Tape Ties
Skin Care...............................................................................12
What You Will Need
How to Clean Around the Opening
Changing the Tube................................................................13
What You Will Need
How to Change a Cuffed Tube
How to Change a Cuffless Tube
Inner Cannula Care................................................................17
What You Will Need
Reusable Inner Cannula Care
Replacing a Disposable Inner Cannula
Trach Tube Cleaning Reference Guide....................................20
Solving Problems..................................................................21
Product Description..............................................................23
Speaking Valve......................................................................28
Glossary................................................................................31

3
 How the trach works

The most common reasons for performing a tracheostomy are

to bypass an airway blockage or to provide long-term mechanical
ventilator support. The doctor makes an opening(stoma) through
the skin and tissue of the neck into the windpipe (trachea). Then a
curved plastic tube (trach tube) is placed into the opening through
which you breathe.1

What Changes Occur

While the tracheostomy tube is a good aid to help you breathe
better, it requires care and some changes in the way you do things.
When you breathe through your nose and mouth, the air is filtered,
warmed, and moistened before it gets to your lungs. With a trach
tube, air goes directly into your windpipe and to your lungs without
being filtered, warmed, or moistened.2 You will learn how to make
up for this by using the proper equipment and by learning proper
trach tube care.

4
 Safety tips

If you use a ventilator Follow your doctor’s or hospital’s directions for care. If instructions
! in this guide are different from your training, follow your training.
Routinely check the ventilator safety Review with your doctor and/or home healthcare provider the
and audio alarms to be sure they are various features and accessories for your Shiley™ trach tube.
working properly.
Carefully read the instructions for use booklet included in each
Be sure the ventilator tubes are
properly placed so that they don’t pull
product package.
on the trach tube. Only people who have been trained by a healthcare professional
Don’t twist or pull on the trach should perform trach care.
connector any more than you must.
This may cause discomfort or Always have extra trach tubes on hand for an emergency (one the
disconnect the ventilator tubes. same size and one smaller).
Hold the trach tube in place when
connecting or disconnecting the Do not resterilize Shiley™ trach tubes or attempt to clean them in
ventilator or humidification tubing. boiling water. They are designed for single use only up to 29 days.
When using a ventilator with a Don’t place the plastic trach tube anywhere the temperature is over
fenestrated trach tube, always use a
non-fenestrated inner cannula with a 120°F.
15 mm connector as recomended by
your doctor.
If you have a cuffed trach tube, avoid overinflating the cuff. This can
damage your windpipe. It may also cause the cuff to extend past the
end of the tube where it can restrict or block air flow.

Watch for these signs of infection, and notify your doctor if

present:

∙ Red, inflamed skin at stoma

∙ Foul-smelling mucus
∙ Bright red blood in mucus
If you are unable to remove your trach tube, or if you are unable to
remove the inner cannula, do not force it. Call your doctor.

Remember to:

∙ Avoid dust and mold

∙ Avoid tobacco and other kinds of smoke
∙ Avoid fumes from cleaning solutions such as ammonia or bleach
∙ Be careful using any kind of spray product, such as hairspray,
furniture polish, etc.; you do not want to inhale the mist
∙ Keep clothing away from the trach tube except for a protective scarf
∙ Be sure all caregivers know CPR for trach patients. Hang CPR
instructions where they will be handy in an emergency
∙ Have emergency numbers available in case they are needed

5
 Getting ready to go home

What you will need Getting ready to go home

∙ Blunt-nose scissors Your trach tube gives you the freedom to leave the hospital and
∙ Box of facial tissues resume your life at home. However, they will require regular care to
ensure that it works correctly. That is why you will receive training in
∙ Container
rinse water)
(for catheter
the hospital.

∙ Cotton swabs Ask plenty of questions and take notes during your hospital training
sessions. Make sure you understand the proper methods of trach
∙ Disposable gloves tube care. Practice every chance you get with the help of your
∙ Hydrogen peroxide instructor. The more practice you have, the more confident and
∙ Syringe (if you have a
cuffed tube)
comfortable you will be once you go home.
Have family members or a friend attend the instruction at the
∙ Precut trach dressing hospital so that they can help you if needed. It is always good to
∙ Replacement trach tubes
(one the same size and
have someone you can turn to for help if you are sick or if there is an
emergency.
one smaller) Your doctor, nurse, or therapist is your best source for advice. This
∙ Small wash basin handbook will provide helpful tips and reminders so that things can

∙ Sterile 4 x 4 in. gauze

pads
go smoothly once you are home again.

∙ Sterile normal saline or

distilled water (to soften
mucus so that it may be
suctioned)
∙ Suction catheter Suction
machine with connecting
tubing
∙ Trach tube mask
(optional)
∙ Twill tape or other trach
tube holder (to secure
the tube in place)
∙ Water-soluble lubricant

!
Note: Some items come from your
home healthcare supplier; others you
will need to buy at the store.

6
 Tips for daily living

What you will need Humidification

in a travel kit
Normally, your nose and mouth would moisten the air you breathe
∙ Blunt-nose scissors to protect the lining of your lungs. With a trach tube, you have to
∙ Breathing medications
(if you use them)
moisten the air another way. That’s why it is important to drink
plenty of liquids and use a humidifier or an “artificial nose” to

∙ Manual resuscitation
bag (if ordered by
moisten and warm the air before going into the lungs.1

doctor) Bathing
∙ Portable suctioning
device
While a little moisture is good, too much can cause problems. So,
when you shower, direct the shower spray at chest level and place a
∙ Spare trach tubes with
obturator and ties (one
shower shield or protective covering over your trach tube. Be careful
to keep soap and water away from the tube and stoma when washing
the same size and one your face. Also, take care to cover your trach tube when you are
smaller) shaving or using powders, hair spray, etc., around your face and neck.2
∙ Suction catheter
∙ Tissues
Illness
For trach patients, eat a healthy diet, get plenty of rest, and avoid
contact with people who have colds or infections.
If illness occurs, you may need to suction more frequently. Be sure
to get plenty of fluids, particularly if you have symptoms of fever,
vomiting, or diarrhea. If you vomit, cover the trach tube with an
artificial nose or towel to keep vomit out of your airway. If you think
vomit may have entered the trach tube, suction immediately.2

Clothing
The main concern about clothing is that it does not block the trach
tube. Avoid crew necks and turtlenecks in favor of V-necks and open
! collar shirts or blouses. Also, do not wear clothes that shed fibers or lint.
Note: Appropriate humidification, when
indicated, helps ensure that the cannula
and fenestration remain open and Getting Out
function properly.
If your doctor says you can leave home to go shopping or visit friends,
do it. It is a wonderful break from the routine, and it will lift your spirits.
Just take along a travel kit (see above).
If it’s very cold outside, be sure to wear an artificial nose or loosely
cover the trach tube with a scarf, kerchief, or gauze. This helps to
warm the air as you breathe, so that the cold air doesn’t irritate your
windpipe and lungs. It also helps keep out dust or dirt on windy days.2

7
 Suctioning

Read before suctioning The lungs and windpipe naturally produce mucus. The mucus cleans
! the air as we breathe by trapping small particles. It then moves up
the windpipe until it can be swallowed or coughed out.
Note: Always follow your doctor’s
or hospital’s directions if they differ
from the directions in this handbook. With a trach tube, mucus can collect in and around the trach
Carefully review with your doctor tube. This mucus must be removed so it doesn’t dry and block
or home healthcare provider the
appropriate recommendations to
the tube. How frequently you suction will be determined by the
determine the appropriate size suction amount of secretions that you have and by your doctor or home
catheter for your tube. The following healthcare provider.2
table can be used as a guide to help
select the suction catheter size based
on the internal diameter of the tube.
Trach Tube Suction
Note: before suctioning a fenestrated Internal Diameter Catheter
tube, make sure the non-fenestrated
inner cannula is in place. 5.0 mm 10 Fr.
Note: if you require removal of pooled
secretions above the cuff, follow the 5.5 mm 10 Fr.
instructions of your doctor or home
healthcare provider. 6.0 mm 10 Fr.
6.5 mm 12 Fr.
7.0 mm 14 Fr.
8.0 mm 14 Fr.
9.0 mm 14 Fr.

What you will need

∙ Collection
secretions
jar for

∙ Container for water

∙ Disposable gloves
∙ Distilled water or saline
∙ Suction catheter
∙ Suction machine

8
 How to suction

Read before suctioning Follow this suction procedure only if directed by your ­physician.
!
1. Wash hands.
Note: Follow the hospital or home
healthcare provider’s instructions for
2. Put on gloves.
storage, use, and disposal of suction 3. Attach suction catheter to suction machine.
catheters. Also, keep the suction
machine, tubing, and collection 4. Rinse catheter by suctioning sterile water.
jar clean according to the home
healthcare provider’s instructions.
5. Hyperoxygenate by taking 3 to 4 deep breaths.
Note: It is common to see suctioning 6. With your thumb off the thumb hole, gently insert the catheter
using a sterile technique in hospitals. into the trach tube until it reaches the end of the tube or until
In the home setting, a clean you cough.
technique may be used. Discuss this
with your home healthcare provider. 7. Cover the thumb hole on the catheter to suction.
8. Slowly remove the catheter while rolling it between your thumb
and pointer finger. Also pulse the suctioning by covering and
uncovering the thumb hole of the catheter. (Start to finish, this
process should take no longer than 10 seconds.)
9. If you need to suction again, rinse the catheter in sterile water
first and take another 3 to 4 deep breaths, then repeat the
suctioning stage. (Allow enough time between each catheter
insertion for normal breathing or ventilator support to re-
oxygenate your body.)
10. Look at the mucus you have suctioned. Normal: Clear, with no
odor. Infection: Yellow or green color with foul-smelling odor.
Blood: A few streaks of blood is OK. But if it has more bright red
or old dark blood, call your doctor.
11. If you see signs of infection or bright red blood, call your doctor.

7 10

9
 Changing ties

Read before changing ties It is important to keep the area around the stoma clean to help
! prevent infection. So, change ties daily or whenever they become
wet, dirty, or loose.
Caution: If you use a cuffed tube,
protect the inflation line when cutting
the ties. How to Change Twill Tape Ties
Note: Change the location of the knot
to prevent skin irritation. 1. Wash hands. (An assistant, if present, must wash hands, too.)
2. Leave old ties in place. Pull one end of the twill tie (under the old
ties) through either neck flange hole. Adjust the ends of the tie
until one is 3 to 4 inches longer than the other.
3. Bring both ends of the tie around your neck and insert the
longer end of the tie through the other neck flange hole.
4. Pull the tie snug. Place one finger between the tie and the neck and
tie the two ends together using a square knot. Do not use a bow.
5. Cut the ends of the ties leaving only 1 or 2 inches.
6. Carefully cut and remove soiled ties.

What you will need

∙ Blunt-nose scissors
∙ Disposable gloves
∙ Twill tape or Shiley trach
tube holder
™

3 4 5

10
 Skin Care

Read before cleaning Skin care is easy but very important. It should be done at least twice
around the opening a day: once in the morning and once at night. If you smell an odor
! around the neck or stoma, clean the area every eight hours until the
Caution: Watch for red, irritated
odor is gone.
areas. If excessive redness or pimples
occur around the opening, call your How to clean around the opening
doctor, reduce humidity delivered
around the opening, and use only
sterile water for cleaning. Do not use 1. Wash your hands.
over-the-counter, petroleum-based
creams like zinc oxide or Vaseline™*
2. Dip a cotton swab into the hydrogen peroxide and water mixture.
products around the opening. If your 3. Roll the cotton swab between the trach tube and the skin around
doctor prescribes an ointment, apply
it according to his or her instructions.
the stoma. Clean from the stoma outward. This removes wet or
dried mucus.
4. Repeat steps 2 and 3 using a fresh cotton swab each time, until
entire area around the stoma is clean.
5. Rinse the area using a clean cotton swab dipped in clean water only.
6. Use a dry gauze pad to pat lightly around the opening.
7. Replace the trach dressing, if required.

What you will need

∙ Cotton swabs, Hydrogen

peroxide and sterile water
(mixed in equal parts)
∙ Precut trach dressing, if
required
∙ Sterile gauze pads
3

11
 Changing the tube

Read before changing Changing your trach tube at the recommended intervals helps to
any tube ensure proper operation of your Shiley™ trach tube. Your tubes
! should not be used more than 29 days and should be replaced and
discarded per your doctor’s instructions.
Caution: Frequent and routine
changes of the trach tube are
recommended. Shiley™ trach tubes How to change a cuffed tube
should not be used more than 29 days
and should be replaced and discarded
per your doctor’s instructions. 1. Wash hands. Put on gloves.
Note: Always follow your doctor or 2. Take the replacement trach tube out of its container. Take
hospital’s directions, if they differ care to avoid damaging the cuff, inflation line, or pilot balloon.
from the directions in this handbook.
Do not attempt to change your trach
Remove the inner cannula, if it is in place.
tube unless you have been trained to 3. Use a clean, dry syringe to inflate the cuff to the proper leak
do so. Contact your doctor or hospital
with any questions you may have.
test volume. The markings on the syringe show air volume. The
following are test volumes only. Your doctor will tell you the
Note: Always keep complete, sterile
replacement trach tubes handy (one appropriate inflation volume to use when the tube is in your
the same size and one smaller) in case trachea.
of an emergency.
4. Place the entire tube, including inflation line, in a small wash
Note: Shiley™ trach tubes are
designed for single-patient use only
basin with enough sterile water to cover it, and watch for
and cannot be resterilized by any bubbles indicating an air leak.
method.
Caution: Carefully read and
understand the Instructions for Use
packaged with each trach tube before
using it.

2 4

12
 Changing the tube

Read before changing 5. Deflate the cuff completely using a syringe. As you are doing
a cuffed tube this, gently push the cuff away from the end of the tube. Be sure
! to remove all air. (This makes it easier to insert the tube.)
Note: During the leak test, if you see 6. Insert the ties through one neck flange hole (under the old
any air leaks, do not use the tube. ones). Insert the obturator into the cannula. (Do this before
Caution: Carefully air-dry the inflation inserting the tube.)
line before inflating to ensure no
water enters when you inflate
7. Lubricate the tube using a thin layer of water-based lubricant.
the cuff. 8. Place the tube on a sterile surface.
Caution: Do not use anything sharp 9. If required, suction secretions that might have pooled above the
while handling the cuff to avoid
causing damage to it. cuff of the old tube. Follow your doctor’s or hospital’s directions
Note: Do not use petroleum-based
for this procedure.
products, such as Vaseline™* jelly, to 10. Deflate the cuff completely using the syringe, cut the ties, and
lubricate your tube.
remove the old tube.
Note: If you have a fenestrated
tube, insert the inner cannula before 11. As you breathe in, gently insert the new tube, pushing back and
inflating the cuff. then down in an arcing motion.
Note: If you use a fenestrated tube,
make sure the cuff is fully deflated
prior to using a decannulation plug.

6 8

What you will need

∙ Blunt-nose scissors
∙ Disposable gloves
∙ Precut trach dressing
∙ Replacement trach tube
∙ Small wash basin
∙ Sterile 4 x 4 in. gauze
∙ 10 cc syringe (for cuffed
tubes)
10 11

∙ Twill tape or Shiley

trach tube holder
™

∙ Water-based lubricant

13
 Changing the tube (cont’d.)

12. Immediately remove the obturator, while holding the tube in

place with your fingers.
13. Insert the new inner cannula making sure that it is properly
secured in place. If you use a twist-lock inner cannula, it is
secure when you feel it lock into place and the blue dots on
the inner and outer cannulae are lined up. If you are using a
disposable inner cannula, make sure that both sides of the
winged flange are snap-locked securely in place.
14. Inflate the cuff to the proper volume using a syringe. (Your
doctor will tell you what volume to use.)
15. Finish fastening the ties as described on page 9.
16. Throw away the old tube.

12 13

13 13

14
 Changing the tube (cont’d.)

Read before changing How to change a cuffless tube

your tube
! 1. Wash hands. Put on gloves.
Note: You probably won’t have trouble 2. Insert the ties through one neck flange hole (under
inserting the new tube. But if you do, the old ones). Insert the obturator into the cannula.
be sure your head is tilted back as you
(Do this before inserting the tube.)
insert the tube. If you are still having
difficulty, spread the skin around the 3. Lubricate the tube using a thin layer of water-based
stoma and insert the tube as you are
lubricant.
breathing in or use a fresh tube that is
a size smaller. Call your doctor 4. Place the tube on a sterile surface.
immediately if you have any problems.
5. If required, suction secretions.
6. Cut the ties and remove the old tube. If you are
unable to remove it, call your doctor. Do not force it.
7. As you breathe in, gently insert the new tube,
pushing back and then down in an arcing motion.
8. Immediately remove the obturator, while holding
the tube in place with your fingers.

2 4

7 8

15
 Changing the tube (cont’d.)

9. Insert the new inner cannula making sure that it is properly

secured in place.
10. If you use a twist-lock inner cannula, it is secure when you
feel it lock into place and the blue dots on the inner and outer
cannulae are lined up. If you are using a disposable inner
cannula, make sure that both sides of the winged flange are
snap-locked securely in place.
11. Finish fastening the ties as described on page 9.
12. Throw away the old tube.

9 10

10 11

16
 Inner cannula care

Read before starting Reusable inner cannula care

inner cannula care
! 1. Wash your hands.
Note: The cleaning procedure 2. Hold the neck flange steady with one hand.
should be clearly understood before
3. With the other hand, grasp the twist-lock inner cannula connector
proceeding. Follow your physician’s
recommendations for the cleaning and carefully unlock it using a counterclockwise motion.
procedure and schedule. The listed
4. Pull the inner cannula out of the tube, using a downward motion.
procedure is to be used only if your
physician instructs you to. 5. If you need to use a ventilator during this cleaning procedure,
Note: The spare inner cannula (SIC) you may reconnect the ventilator to the tracheostomy tube
should not be used as a replacement without the inner cannula
for the inner cannula provided with
your trach tube. 6. Place the dirty inner cannula in a small wash basin containing
Note: To loosen dried-on mucus, use sterile normal saline, distilled water, a solution of water, and a
a mixture of equal parts of hydrogen mild detergent or a solution of half hydrogen peroxide and half
peroxide and distilled water. Pour this water. Use a small, nonabrasive brush or pipe cleaner to gently
mixture through the inner cannula.
Do not soak. Rinse the inner cannula remove mucus.
thoroughly with sterile normal saline 7. After cleaning, rinse the inner cannula thoroughly with sterile
or distilled water to remove
all hydrogen peroxide. normal saline or distilled water to remove all hydrogen peroxide.
Caution: Do not use cleaning agents
such as alcohol, glutaraldehyde,
or bleach. They will damage the
inner cannula.

17
 Inner cannula care (cont’d.)

What you will need

∙ Disposable gloves
∙ Mild soap such as Ivory
∙ Hydrogen peroxide and
sterile water (mixed in
equal parts)
∙
Small nonabrasive brush
or pipe cleaners
∙
Small wash basin
∙
Spare inner cannula if
using reusable inner
8. Air-dry the inner cannula by gently shaking it.
9. Hold the neck flange steady with one hand.
cannula tube
10. Remove the spare inner cannula, if you used one.
∙
Sterile 4 x 4 in. gauze
11. Reinsert the clean inner cannula into the tube and secure it.
12. Clean the spare inner cannula if necessary, air-dry, and store in a
safe place.

18
 Inner cannula care (cont’d.)

Read before starting Replacing a disposable inner cannula

inner cannula care
! The disposable inner cannula system eliminates the need to
clean the inner cannula. The snap-lock feature provides a secure
Caution: A Shiley™ disposable inner
cannula should never be cleaned and connection and makes it easy to insert and remove the disposable
reused. It is designed for inner cannula with little or no discomfort.
one-time use only.
Note: The disposable inner cannula 1. Wash your hands.
should be changed and discarded
according to the schedule your 2. Hold the neck flange steady with one hand.
doctor or home healthcare provider
gives you.
3. With the other hand, gently squeeze the snap-lock or pinch tab
and pull the inner cannula out of the tube, using a downward
motion.
4. Throw away the used inner cannula.
5. Gently squeeze the snap-lock of the new inner cannula and
insert it into the tube. Release the snap-lock ­connector when it
securely locks onto both sides of the connector rim.

19
 Trach tube cleaning reference guide

Read before cleaning

your tube
!
Caution: Shiley™ trach tubes are
designed for single-patient use only
and cannot be resterilized by any
method, including soaking and/or
rinsing them in boiling water.
Note: Do not expose Shiley™ trach
tubes to temperatures above 120 F.
Note: Do not expose Shiley™ trach
tubes to any chemical agents, other
than those listed above, because they
may degrade the plastic (polyvinyl
chloride). This will result in tube
damage.
Note: Detergents with artificial
colors, degreasers, or sterilizing/
antibacterial ingredients may
discolor the trach tube. They may
also degrade the plastic (polyvinyl
chloride) resulting in tube damage.
Caution: A Shiley™ disposable inner
cannula should never be cleaned and
reused. It is designed for one-time
use only.

Name Hydrogen Normal Saline Water and Alcohol Boiling in Autoclave Betadine™*
of Part Peroxide and or Mild Water ETO/ Solution
Water (1/2 & 1/2) Distilled Water Detergent Gamma
Reusable inner
*Yes Yes *Yes No No No No
cannula
Disposable
No No No No No No No
inner cannula
Outer cannula
No No No No No No No
(cuffless)
Outer cannula
No No No No No No No
(cuffed)
Decannulation
*Yes Yes *Yes No No No No
plug (DCP)
Disposable
decannulation No No No No No No No
plug (DDCP)
Obturator *Yes Yes *Yes No No No No

*Do not use solutions other than those recommended. Hydrogen peroxide or other oxidizing agents may be harmful to the device.

20
 Solving problems

Symptom What May Have Happened What To Do

Excessive air leak through nose Insufficient air in cuff (cuffed Deflate and reinflate the cuff with
and mouth. tubes only). the proper amount of air.

Leak in cuff, inflation line, Replace the tube.

pilot balloon, or luer valve
(cuffed tubes only).

Tube too small for trachea. Call your doctor.

You may have an uncuffed tube Call your doctor.

and need a cuffed tube.

Fenestrated inner cannula is in the Remove it and replace it with a

tube. nonfenestrated inner cannula.

Tube comes out of the opening in Excessive pulling or weight at the Hold the neck flange with one
the neck. connector. hand while disconnecting the
ventilator tubing to reduce
pulling. Move the ventilator if need
be. Reattach the ventilator tube
to the trach tube connector.

Trach tube ties too loose or incor- Retie the trach ties (see page 9).
rectly tied.

Difficult to remove or insert inner Tracheal lining may be pushing Call your doctor.
cannula for fenestrated tube. through the fenestration.

Trach tube alignment has Call your doctor.

changed.

Tube, or any part of the tube, Excessive use or wear on the Replace the tube.
breaks or doesn’t work. trach tube.

Trach tube was cleaned using Replace the tube. Always use only
improper cleaning agents. those cleaning agents
recommended by the tube
manufacturer (see page 16).

Excessive pulling or weight at the Hold the neck flange with one
connector. hand while readjusting ventilator
tubing to reduce pulling. Move
the ventilator if need be. Put the
ventilator tube adapter back onto
the trach tube connector.

Trach tube ties are too loose or Make sure tube is properly
incorrectly tied. inserted in the trachea. Then retie
trach ties (see page 9).

21
 Solving problems

Symptom What May Have Happened What To Do

Unable or difficult to pass a Mucus is plugging the trach tube. Remove inner cannula and clean
suction catheter through it, if reusable. Replace it if
trach tube. disposable.

Catheter is too large for the Contact your doctor, nurse, or

tube size. therapist for guidance in the size
of catheter needed.

Tube is not properly positioned in Reposition the tube.

the trachea.

A fenestrated inner cannula is in Replace it with a nonfenestrated

the tube. inner cannula.

Ventilator’s “High Pressure” Ventilator tubing is blocked Clear tubing of kink or block.
alarm goes off. or kinked.

Mucus is plugging the trach tube. Suction to clear mucus.

Excessive amounts of water have Drain the ventilator circuit

collected in the ventilator circuit, of water or condensation.
blocking airflow.

If the first three suggestions don’t Contact your doctor, nurse, or

work, there may be a more seri- therapist immediately.
ous problem.

Ventilator’s “Low Pressure” Ventilator tubing is not Make sure all tubing to the
alarm goes off. connected at machine. machine and patient is
connected.

If you have a cuffed trach tube: Remove the ventilator tubing

There may be a leak in the cuff, from the trach tube. Deflate and
inflation line, pilot balloon, or reinflate the cuff with the proper
luer valve. volume. Replace the tube if it does
not remain inflated. Attach venti-
lator tubing. Turn on the machine.
If the problem
continues, replace the tube.

A fenestrated inner cannula is in Replace it with a nonfenestrated

the tube. inner cannula.

If the first three suggestions don’t Contact your doctor, nurse, or

work, there may be a ventilator therapist. Deliver breaths with
problem. a manual resuscitation bag,
if available.

22
 Product Descriptions

1. Cuff
The “balloon” on the end of the trach tube. When inflated, it forms
a seal against the wall of your windpipe. This stops the airflow
through your mouth and nose so that you breathe through the
trach tube. Some trach tubes do not have a cuff. Please consult
your doctor if you have questions about the type of trach tube
prescribed to you.
2. Inflation line
Thin plastic tubing that carries air to and from the cuff.
3. Pilot balloon
Small plastic balloon-like component on the end of the inflation
line. Indicates if air is in the cuff.
4. Luer valve
Where the syringe is connected to inflate or deflate the cuff.

5. Soft swivel neck flange

Contains product designation and size information. Twill ties or
Shiley™ trach tube holders attach through the holes on either side
securing the tube to your neck. Soft swivel design helps to position
the tube properly and comfortably.
6. Reusable inner cannula
The tube that fits inside your trach tube. This can be easily
detached and cleaned to remove mucus. FEN and CFN have a
fenestrated inner cannula.
7. Fenestration
A hole on the curved part of the trach tube or inner cannula. When
a fenestrated inner cannula is used or the nonfenestrated inner
cannula is removed, it allows air to flow through the vocal cords,
mouth, and nose so you can speak.
8. 15-mm connector
A universal connection for ventilator tubing, manual resuscitation
bag, speaking valve, or artificial nose.
9. Decannulation plug
For use with FEN and CFN. Attaches to the trach tube opening
when the inner cannula has been removed and the cuff has been
deflated. Directs air through fenestration to your mouth and nose.

10. CAP
Fits over the 15-mm connector and directs air through
fenestration to your mouth and nose so you can speak.

23
 Speaking Valve

! Shiley™ Speaking Valve

Warning: Ensure that oxygen tubing
(SSV/SSVO)
does not excessively tug or pull at
speaking valve attachment. Description
The Shiley™ phonate speaking valve The Shiley™ phonate speaking valve is designed to eliminate the
should only be used, on the order of
need to use your finger to block the opening of your trach tube in
a doctor, with patients who are alert
and cooperative. order to talk. It is a one-way valve that attaches to the
The Shiley™ phonate speaking valve
15-mm connector of your trach tube, including pediatric sizes. It
should not be used during sleep. is available without an oxygen port (SSV) or with an oxygen port
The Shiley™ phonate speaking valve is (SSVO).
not designed to be used by patients
who are ventilator dependent.
Contraindications
Use the Shiley™ phonate speaking The Shiley™ phonate speaking valve is not for use by patients
valve only with a cuffless tube or a
fenestrated cuffed tube. If a cuffed
who have laryngeal stenosis, vocal cord paralysis, severe tracheal
tube is used, the cuff must be stenosis, airway obstruction, respiratory infection, or heavy
completely deflated. Do not use with pulmonary mucus secretions.
foam cuff tubes.
Caution: Do not attempt to remove
How the Shiley™ phonate speaking valve works
the flexible diaphragm from the valve
cap. When the phonate speaking valve is attached to the 15-mm
Use the Shiley™ phonate speaking
connector or hub of a fenestrated or cuffless trach tube, the valve
valve only after secretions have opens when you breathe in, allowing air to enter your lungs. When
minimized following trach. you breathe out, the valve closes and causes air to go up your
Pediatric patients should not use the windpipe and through your vocal cords, allowing speech.
Shiley™ phonate speaking valve with
oxygen port (SSVO) unless the port
cap is not accessible to the patient.
Note: The Shiley™ phonate speaking
valve should only be used on the
order of a physician. Your home
healthcare provider will decide if the
Shiley™ phonate speaking valve is
right for you.
The Shiley™ phonate speaking valve
should be replaced after 30 days of
normal use.
Replace the Shiley™ phonate speaking
valve should the flexible diaphragm
become damaged, sticky, or
malfunction in any way.

24
 Speaking Valve

! How to Use the Shiley™ phonate Speaking Valve

Note: If oxygen port is blocked
or obstructed, use a moistened 1. Wash hands thoroughly.
cotton swab, with some of the
cotton removed, or pipe cleaner, to
2. Carefully hold the trach tube with one hand while grasping the
gently remove any remaining debris Shiley™ phonate speaking valve with the opposite hand.
or encrustation. Rinse again and
reexamine. See complete cleaning
3. Attach valve to the 15-mm connector using a gentle twisting
instructions on the next page. motion. (Remove the Shiley™ phonate speaking valve if any
Note: The Shiley™ phonate speaking respiratory distress or difficulty in breathing occurs.)
valve is designed for single-patient
4. To remove the Shiley™ phonate speaking valve, carefully hold
use only.
the trach tube with one hand, while pulling the device from the
trach tube with a gentle twisting motion.
5. If using the phonate speaking valve for the first time, your
home healthcare provider and/or speech pathologist will want
to observe your breathing for a period of time to make sure
you can breathe well around the trach tube and speak without
difficulty.

Using the Shiley™ phonate Speaking Valve with Oxygen Port

(SSVO)

To provide supplemental oxygen when the oxygen port is present,

remove the oxygen port cap, connect the oxygen line tubing, and
adjust the oxygen flow rate to prescribed setting.

25
 Speaking Valve (cont’d.)

Cleaning

The Shiley™ phonate speaking valve should be cleaned daily while in

use. If mucus or secretions become attached to the device, clean
immediately.

1. Wash hands.
2. Remove the Shiley™ phonate speaking valve by carefully holding
the trach tube with one hand, while pulling the device from the
trach tube with a gentle twisting motion.
Caution: Do not use a brush for
cleaning as it will cause damage 3. Open the valve cap by pressing the cap lid away from the body at
to the valve. a position opposite the hinge.
Do not use hot water as it will damage
the valve.
4. If an oxygen port is present, do not apply excess pressure
to the side of the port when opening the cap lid.
Do not use bleach or alcohol to clean
the valve. 5. Prepare one of the following cleaning solutions:
Do not use ETO, autoclave, or
∙ Cool or lukewarm saline
∙
radiation to sterilize the valve.
Soapy water
(a pure soap such as Ivory™* brand is recommended
∙ Diluted household strength hydrogen peroxide
(one part water and one part peroxide)
∙ Diluted household strength vinegar
(one part water and one part vinegar)
6. Soak the opened valve in the cleaning solution for up to
15 minutes.
7. After the soaking period, agitate the valve in the
cleaning solution.
8. Thoroughly rinse the valve in cool or lukewarm tap water
to remove all cleaning solution.
9. Examine the valve for remaining debris or encrustations. Ensure
that the flexible diaphragm is clean, not torn or sticky, and that it
lies flat in the valve cap.
10. Check inside the valve to make sure it is smooth and undamaged.
If you have an oxygen port, use a pipe cleaner or cotton swab,
with some of the cotton removed, to clean inside the port.
11. Close the valve by firmly pressing the valve cap onto the main
body until it snaps in place.
12. When not in use, store the Shiley™ phonate speaking valve in
a clean, dry place and protect from dust and moisture.
13. Always review use and cleaning instructions with your home
healthcare provider or speech pathologist before using the
Shiley™ phonate speaking valve.

26
 Glossary

Aerosol (air-o-sol) Home healthcare supplier

A device that puts moisture into the lungs. The company where you get special medical
equipment to use in your home.
Artificial airway (ar-teh-fish-all airway)
Another word for trach tube Lumen (loo-men)
Inside part of the tube, where the air goes in
Artificial nose (ar-teh-fish-all noze) and out.
Also called HME (heat and moisture exchanger).
A device that fits on your tube to warm and Mucus (mu-kuss)
moisten the air you breathe. Slippery fluid that is produced in the lungs and
windpipe. This sometimes dries and sticks to
Bacteria (back-teh-ree-ah) your tube.
Germs.
Neck flange
CPR Cardiopulmonary resuscitation The part of your trach tube where you attach
A method for getting someone to breath again twill ties or Shiley™ trach tube holders.
once they have stopped.
Obturator (ob-tur-a-tor)
Cannula (can-you-la) The semirigid stick you put into the trach tube
Inner cannula Removable inner tube. to help guide it into the opening in your neck.

Outer cannula Phonation (fo-nay-shun)

The outer part of the trach tube that is inserted Talking or making sounds with your vocal cords.
into the trachea.
Pliable (ply-ah-bull)
Cannulae (can-you-lie) Soft, flexible.
More than one cannula.
Saline (say-leen)
Cuff Salt and water solution similar to water found in
The inflatable balloon on some trach tubes. the body.

Sterile water Secretions (see-kree-shuns)

Water that is made by catching and cooling Another word for mucus.
steam from boiling water. You can buy it at the
grocery store. Speaking valve (spee-king valv)
A one-way valve that lets air come in through
Encrustation (in-cruss-ta-shun) the trach tube, but then sends it out past the
Hard, crusty, dried mucus. vocal cords and mouth
to make talking possible.
Home healthcare provider
Nurses, nurse practitioners, doctors, Speech pathologist (speech pathol-o-gist)
respiratory therapists, speech pathologists, or A person trained to help people with speaking
others that visit your home. and swallowing problems.

27
Glossary (cont’d.)

Shiley™ phonate speaking valve Stoma (sto-ma)

This compact valve fits on the end of your trach The hole in your neck where you insert the
tube to help you speak more easily. Check with trach tube.
your doctor to see if you can use it. (For more
information, see page 25.) Sterile (steer-ill)
Free from germs.

Suctioning (suck-shun-ing)
Removing mucus in the trach tube.

Syringe (seer-enj)
The plastic device the doctor uses to give
shots, only there is no needle on it.

Trachea (tray-key-ah)
Your wind pipe.
Shiley™ trach tube holder
This convenient alternative to twill tape comes Tracheostomy (tray-key-oss-tuhmee)
in one size that fits pediatric to adult patients. The opening in your neck where your trach
Hook and loop fasteners easily attach to tube goes, to make breathing easier.
the trach tube neck flange. (Follow product
instructions.) It is made of comfortable, latex- Tracheotomy (tray-key-ot-o-mee)
free foam-padded cotton. An operation where the doctor makes an
opening in your neck for a trach tube to make
breathing easier.

Trach Tube (trake toob)

Short for trach tube. This is the tube the doctor
puts in the opening in your neck to help you
breathe.

Ventilator (vin-till-a-tor)
A machine that helps a person breathe.

Vocal cords (vo-cal cords)

Two strips of tissue in the voice box in the neck
that vibrate to make sounds when you talk.

1. Durbin C. Tracheostomy: why, when, and how? Respir Care. 2010;55(8): 1056–1068.
2. Arakawa-Sugueno L. What Is the Best Way to Take Care of a Patient with a Tracheostomy
Tube? Tracheostomy. 2017:377-390. doi:10.1007/978-3-319-67867-2_22

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