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Inner Lumen

Failure to provide adequate humidification and cleaning of inner lumen  has resulted in the inner lumen of the tracheostomy becoming blocked with purulent secretions

All patients wherever possible will have a double lumen tube in situ. Exceptions include mini-tracheostomy, paediatric patients, and tubes with an adjustable flange.  The incidence of tube blockage can be reduced by the use of an inner lumen that can be easily removed for cleaning then replaced.  Inner tubes may be fenestrated or non-fenestrated.

Indications for Cleaning

DOUBLE LUMEN TRACHEOSTOMY TUBES ONLY

.Tracheostomy EmergenciesIf tracheostomy tube has an inner tube it must be cleaned to ensure it does not become blocked with secretions.  If you suspect tube occlusion this should be regarded as a clinical emergency. For further information see section on

The frequency with which cleaning is required will vary between patients. Each must be individually assessed.  Factors which should be considered are: 

  • Amount and consistency of secrions
  • Presence of secretions which are not cleared by tracheal suction
  • Patient requestIf patients are receiving oxygen consider pre-oxygenation prior to removing the inner lumen. Where possible, replace the inner lumen with the spare lumen to allow continued flow of oxygen to be available to the patients. 

Look for signs that the patient’s tube may be becoming occluded. Early detection could prevent a clinical emergency

  • Increased respiratory rate
  • Continual coughing unrelieved by suction/expectoration
  • Noisy breathing
  • Patient complaining of increased breathlessness
  • Decreased SaO2
  • Respiratory distress
  • Difficulty in passing a suction catheter via the tracheostomy tube
  • Cardiovascualr instability
  • New confusion/aggitation

This is not an exhaustive list and staff must use clinical  judgement to assess patient well-being.

When using the fenestrated inner lumen please note that the oxygen delivered may be reduced. 

Only use the inner lumen supplied by the manufacturer to prevent tracheal erosion, and secretion build up.  The inner lumen should be cleaned in accordance with the manufacturers’ instructions and Hospital Infection Control Policy which states  that sterile water or saline should be used.

The spare inner lumen when not in use, must be stored, dry, in a clean airtight container or when appropriate discarded.

Some manufacturers’ two piece tube systems do not allow for a permanent 15mm connection when the inner lumen is removed (for cleaning or weaning). During emergency situations replace the inner lumen to facilitate oxygenation, suction, etc.

Equipment required:

  • Disposable gloves
  • Tracheostomy cleaning swabs
  • Sterile container (for spare tube)
  • Sterile water
  • Spare inner lumen

with fenestrated tubes there should always be both a fenestrated and non-fenstrated inner lumen available.NB

Click here for instruction on how to clean the inner lumen of a double lumen tracheostomy tube

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