Preparation - Tracoe Comfort Instructions D'utilisation

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6. Tubes with a Connector / Adapter
6.1 Tubes with a 15 mm Connector
TRACOE comfort tubes with a 15 mm connector are used, for example,
for the placement of a heat and moisture exchanger (HME), which
filters, moistens and heats the inhaled air (e.g. TRACOE humid assist
IV REF 642).
As an alternative to the speaking valves type A or B, a speaking
valve with a silicon membrane (e.g. TRACOE phon assist REF 650-T,
REF 650-TO or REF 655-T) can be placed on the 15-mm connector of
a fenestrated comfort tube (e.g. REF 115).
Caution: In order to loosen very tight connections, such as the connec-
tion between a heat and moisture exchanger and a 15 mm connector,
a suitable separating aid should always be used. Please note that the
tracheostomy tube might be damaged by unsuited tools.
6.2 Tubes with a 22 mm Adapter
TRACOE comfort tubes with a 22 mm adapter are also used
for attaching heat and moisture exchangers, for example the
TRACOE humid assist I REF 640-S, and speaking valves like the TRA-
COE phon assist REF 650-S and REF 655-S.
7. Application of the TRACOE comfort Tubes
7.1

Preparation

In general, before inserting the tube into the tracheostoma, you should
check if the inner cannula can be easily inserted into the outer cannula.
Please do not use any other products than the TRACOE Liquid Paraffin
REF 902 for lubrication. Other oils, for example stoma oil, might stick
the inner cannula to the outer cannula.
On one side of the neck flange, the neck strap (for example REF 903-F)
is attached. Then a tracheal compress, for example REF 910-A or -B,
is pushed over the cannula tube.
The insertion of the tube is made easier by moistening the outside of
the cannula tube with a water-soluble lubricating gel.
7.2 Inserting the Tube
Hold the tube at the neck flange with one hand and spread the
tracheostoma between the index and middle finger of the other hand.
Carefully push the tube into the tracheostoma during the inhalation.
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This step is made easier if the patient's head is slightly bent back-
wards. The head can be brought back to the straight position during
the subsequent insertion into the trachea. Finally, the tube is secured
with the neck strap by fixing the strap to the free eye of the neck flange.
Make sure that the tube is positioned free of tension in the tracheos-
toma. The position of the tube should not be changed by the neck
strap.
The removal of the tube is made easier if the patient's head is slightly
bent backwards.
7.3 Handling of the Inner Cannula
If highly viscous secretion collects in the inner cannula, which cannot
be removed by means of suction and obstructs the airflow, there is a
risk that the tube becomes blocked. This can result in acute danger
of asphyxiation.
In this case, the inner cannula must be removed and cleaned. For this
purpose, hold the neck flange of the outer cannula with one hand. With
the other hand, rotate the inner cannula clockwise by a few millimetres
(as seen from the patient with the inserted tube) and pull the inner
cannula out of the outer cannula. The outer cannula remains in the
tracheostoma where it ensures an open and safe airway.
When reinserting the cleaned and lightly oiled inner cannula (see item
8), make sure that the inner cannula is neither twisted nor bent. Push
the neck flange of the inner cannula behind the little hook at the neck
flange of the outer cannula by slightly rotating the neck flange of the
inner cannula. This way, the inner cannula is fixed in its place (see
images 1-3, model with hook at the bottom of the neck flange).
8. Cleaning and Care
The cleaning intervals heavily depend on the main illness of the patient
as well as the secretion volume and consistency, any tendency to crust
forming and the patient's individual needs.
At least the TRACOE comfort inner cannula should be cleaned daily.
The respective application period of the outer cannula for the particular
patient should be cleared with the physician in charge.
Caution: Always remove the tube from the tracheostoma before
cleaning.
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