Three Tracheostomy Tube Designs for Improving Patient Airways, Breathing

Approximately 100,000 Americans require a tracheostomy each year.1 Whether patients need short-term mechanical ventilation or long-term tracheostomy tube use, ensuring an individual’s safety and comfort is important. Choosing the right tube for each patient can enhance their experience and drive positive clinical outcomes. 

To help determine the optimal tracheostomy tube for your patients, we’ve pulled together the following list to help sort features by tracheostomy tube design and type.

While not an exhaustive list of every tracheostomy tube design available, this blog presents each product in the manufacturer’s own words. You may validate all features listed by checking the manufacturers’ websites or contacting their sales representatives.

Related: Want to learn more about tracheostomy tube options for neonates and peds? Read this blog post highlighting tracheostomy tube designs benefitting the smallest of patients.

Shiley™ tracheostomy tubes

Informed by feedback from clinicians intended to improve patient comfort, Shiley™ tracheostomy tubeswere designed with a taper-shaped cuff  and made of a softer, non-DEHP material. These enhanced features help to avoid patient irritation that is typically associated with common PVC materials used in most tracheostomy tubes.

  • TaperGuard™ cuff: Designed to reduce pressure and friction on the esophagus during surgery, the TaperGuard™ cuff is associated with reduced throat soreness and lower tracheal pressures of the lateral wall.2 The TaperGuard™ cuff features a low-pressure, low-volume design, which reduces leakage of fluids in the lower cuff by 99 percent.3
  • Comfortable design: To reduce abrasion at the site of the stoma in a patient, the Shiley™ flexible adult tracheostomy tubes have a soft, recessed flange, as well as a design that makes it possible to ventilate with or without an inner cannula.
  • Transparent flange: The Shiley™ tracheostomy tube supports improved visibility of the stoma and surrounding area. The tube also contains an intentional slight indentation behind the flange to support the health of the skin and reduced irritation.  
  • Improved airflow: The Shiley™ tracheostomy tube helps reduce breathing work, facilitates easier vocalization, and helps patients wean from tracheostomy tubes.4
  • Removable inner cannula: Enhancing support of both clinicians and patients, the removable inner cannula allows for secretion clearing to prevent mucus buildup. A clear connector is included with the Shiley™ tracheostomy tube to help ensure the inner cannula is in place. Both disposable or reusable inner cannula options are available.
  • Expanded range of sizes:  We now offer a full range of sizes. This can allow you to find the optimal fit for your patient

Related: Read one patient’s insights on living with a permanent tracheostomy tube.

TRACOE™* twist tracheostomy tubes

TRACOE™* offers the twist and twist plus lines of tracheostomy tubes — all equipped with a perforated obturator, adjustable neck strap, product information card, and two-detachable labels. Additional features include, but are not limited to, the following: 5

  • Blue, white, and green lettering/grooving: Used to signify various fenestrated and nonfenestrated outer and inner cannulas — the blue, white, and green lettering or grooving supports easier identification for quickly addressing patient care.
  • Larger sizing: TRACOE™* offers larger sizing designed to support heavier and taller patients — including 77 inches or more.
  • Lubricating gel: TRACOE™* supplies lubricating gel for its twist and twist plus p-tubes. Twist P-tubes are also accompanied with reinsertion tubes.
  • Inner cannula correspondence. TRACOE™* focuses on every millimeter counting to diminish potential patient struggles. They note the example of the lumen going from eight to seven — or eight to nine — millimeters to improve patient breathing workload. Each of the twist and twist plus lines correspond accordingly with the “inside diameter of the inner cannula” adjusting to patient needs.

Related: Understand the cost of tracheostomy tubes for adults.

Smiths Medical Bivona™* adult TTS™* adjustable neck flange hyperflex* tracheostomy tube

The Portex™* Bivona™* tracheostomy tubes are designed with an adjustable neck flange hyperflex™* as a one-size-fits-all tubing design. With a wire-reinforced silicone shaft, the Portex™* Bivona™* adult tubes are ideal for patients with “thick or bull necks, obese patients, and trauma patients.”7 Additional features include, but are not limited to, the following: 6

  • Clear flange: Associated with patient comfort, the adult tube design has a clear flange that also helps support tube positioning.
  • Removable inner cannula: The inner cannula adds additional protection with the ability to be removed and cleaned when recommended prior to reinsertion. Ventilation can also occur with or without the inner cannula.
  • Color-coding: The Portex™* Bivona™* adult TTS™* adjustable neck flange hyperflex™* tracheostomy tube designs have color-coded inner cannulas for easier identification to match patients with correct sizing.
  • Flexible outer cannula: A flexible outer cannula is supported. The product does contain DEHP and a blunt tip also where the product information is labeled.

Related: Learn how to reduce tracheostomy pressure-related ulcers at your health facility.


† Previous Shiley™ tracheostomy tubes refers to Shiley™ DCT, DCFS, DCFN, DFEN, LPC, CFS, CFN, FEN, and Perc tracheostomy tubes.

1. Cheung, N.H., Napolitano, L.M. Tracheostomy: Epidemiology, indications, timing, technique, and outcomes. Respiratory Care. June 2014: 59 (6) 895–919.
2. Based on internal test report #10119661. Comparing the Shiley™ flexible adult tracheostomy tube with TaperGuard™ cuff to the Shiley™ DCT tracheostomy tube cuffed. Data on file.
3. Internal benchtop testing results. Results reflect testing the Shiley™ Flexible adult tracheostomy tube with TaperGuard™ cuff, disposable inner cannula at 20 cm H20 versus the Shiley™ DCT tracheostomy tube with disposable Inner cannula at 25 cm H20. Athlone 2013.
4. Mullins JB, Templer JW, Kong J, Davis WE, Hinson J Jr. Airway resistance and work of breathing in tracheostomy tubes. Laryngoscope. 1993;103(12):1367–1372.
5. Tracoe. Twist tracheostomy tubes product page.
6. Smiths Medical. Bivona® adult TTS™ adjustable neck flange hyperflex™ tracheostomy tube product page.

About the Author

Paul DeAngelo is a Respiratory Account Manager for the Shiley™ airway portfolio. For more than 15 years, he has partnered with clinicians and care teams in the healthcare industry to help improve patient outcomes and clinical solutions. The Shiley™ airway portfolio includes Shiley™ tracheostomy tubes, Shiley™ endotracheal tubes, and DAR™ breathing systems.

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