Reference — Clinical Skills
Tracheostomy Tube Types & Sizing
Cuffed or uncuffed, fenestrated or solid, single or dual cannula — the tracheostomy tube types and what each is for, with sizing notes and the speaking-valve rule that can be fatal to get wrong.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
Tracheostomy tubes vary by cuff, cannula design, and fenestration; selection follows the patient’s ventilation, aspiration risk, and speech needs.
Tube Features
| Feature | Description | When Used |
|---|---|---|
| Cuffed | Inflatable cuff seals the trachea | Positive-pressure ventilation, high aspiration risk |
| Uncuffed | No cuff | Stable patient, weaning toward decannulation, most pediatric patients |
| Single cannula | No removable inner liner | Smaller-diameter or specialty tubes |
| Dual cannula (inner cannula) | Removable or disposable inner liner | Standard for secretion management; the inner cannula is cleaned or replaced to prevent occlusion |
| Fenestrated | Opening(s) in the outer cannula | Allows airflow to the upper airway for speech (inner cannula out, cuff deflated, cap on); risk of granulation tissue |
| Non-fenestrated | Solid outer cannula | Standard |
| Extended-length (proximal / distal) | Longer shaft | Proximal for large necks/obesity; distal for tracheomalacia or distal tracheal lesions |
Clinical Notes
Speaking-valve safety.A one-way speaking valve (e.g., Passy-Muir) requires the cuff to be deflated first — placing a speaking valve on an inflated cuff blocks exhalation and can be fatal.
- Sizing. Tubes are sized by inner diameter in millimeters; choose the largest that fits comfortably for adequate airflow and suctioning.
- Cuff pressure.Maintain cuff pressure at 20–30 cmH₂O to prevent tracheal injury while maintaining the seal.
- Bedside equipment. Keep a spare same-size tube, a one-size-smaller tube, and the obturator at the bedside at all times.
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Airway management.
- Cairo JM. Mosby's Respiratory Care Equipment. 11th ed. Elsevier; 2022. Artificial airways.