21
EN
2. Connectors and adapters
Connectors and adapters are used to connect compatible tube accessories.
The options available to a patient depend on the clinical condition, such as status post
laryngectomy or tracheostomy.
Connectors/adapters are normally permanently attached to the inner cannula. The connector
in this case is the universal (15 mm) connector with the aid of which so-called artificial noses
or heat and moisture exchangers (HMEs, filters for exchanging heat and moisture) can be
attached.
This connector is also available in a special version as 15 mm swivel connector. The swivel
version of the 15 mm connector is suitable, for instance when using a respirator tube system,
for absorbing the torsional forces that arise in such situations and for relieving strain on the
tracheostomy tube and stabilising it in position in such a way that irritations of the mucous
membrane in the trachea can thereby be avoided.
The 22 mm combi-adapter can be used to fasten compatible filter and valve systems with 22
mm attachments – such as , but not limited to the HUMIDOPHONE
®
speaking valve with filter
function (REF 46480),
HUMIDOTWIN
®
Heat and Moisture Exchanger (HME) (REF 46460),
COMBIPHON
®
speaking valve (REF 27131), LARYVOX
®
HME filter cassettes (REF 49800).
3. Cannula tube
The cannula tube borders directly on the neck flange and directs the airflow into the trachea.
The swivel connector serves to securely attach inner cannulas and compatible accessories: the
inner cannulas/accessories are fixed in place with only a light rotating movement in clockwise
direction (in inserted condition as viewed when facing the patient), and thus without having to
exert much tension on the tracheostomy tube.
3.1. Low-pressure cuff
In the product versions with low-pressure cuff, the very thin-walled, high-volume low-pressure
cuff adapts well to the trachea and ensures reliable sealing if inflated correctly. The low-pressure
cuff can be inflated like a balloon. The small pilot balloon on the inflation tube indicates whether
the tracheostomy tube is in sealed (inflated) or non-sealed condition.
The low pressure cuff is inflated via a pilot line with one-way valve and pilot balloon.
3.1.1 Leakproofness test of the cannula and the low-pressure cuff (if present)
The cannula and the low pressure cuff must be tested for leakages directly before and after
every insertion and thereafter at regular intervals. For this purpose, inflate the low-pressure
cuff to 15 to 22 mm Hg (1 mm Hg corresponds to 1.35951 cm H2O) and then observe
whether a spontaneous drop in pressure occurs (recommended for inflating and testing:
Cuff pressure gauge control inflator, REF 19500). There should be no substantial drop in
pressure during the observation period. This leakproofness test must also be performed prior to
every renewed insertion (e.g. after cleaning the tracheostomy tube) (see picture 7c).
The following are possible signs indicating leakages in the cuff (balloon):
Externally visible damage to the balloon (holes, fissures etc.)
•
Audible and/or tactile perception of air escaping from the balloon
•
Water in inlet tubes of the tracheostomy tube (after cleaning!)
•
Water in the cuff (after cleaning!)
•
Water in the pilot balloon (after cleaning!)
•
No cough stimulus when pressure is applied to the pilot balloon
CAUTION!
When testing the balloon or when inserting, removing or cleaning the tracheostomy
tube, never under any circumstances use sharp or pointed objects, such as for instance
forceps or clamps, since these can damage or even destroy the balloon. Should one of
the above-named signs of leakage be detectable, the tracheostomy tube must under no
circumstances be used any more since it is no longer functioning properly!
3.2 Obturator
Please check whether the obturator can easily be removed from the cannula before inserting
the tracheostomy tube!
After checking the obturator for ease of movement, reinsert the obturator into the cannula for
inserting the tracheostomy tube.
