Method

Take a cuffed Portex® endotracheal tube of a size similar to that of a tracheostomy tube which you would otherwise use on the same patient. Mark the length required to safely reach the tracheal lumen. If the cuff pilot line is moulded to the ETT above this mark cutting through the tube will result in an incompetent cuff. Therefore carefully cut a sliver of plastic tube along the length of the cuff pilot line above the desired level. After an appropriate length has been achieved inflate the cuff to check its integrity. To make a flange, cut a flat rectangular strip from a firm plastic drip bag approx 1”x 3”. Make an aperture in its middle slightly smaller than the diameter of the ETT. Cut two holes on both ends for the strings to pass through. Remove the connector from the discarded top end of the ETT. Pass its tip through the central aperture of the improvised flange and firmly insert it in the cut ETT. Move the improvised flange to confirm that it is secured between the top of the ETT and the lower surface of the connector. The sliver of plastic cut along the cuff pilot line lies below the self made flange and prevents it from sliding down the tube. Your extra length modified tracheostomy tube is ready for use. (Fig.1) .A comparison of ETT, regular and modified tracheostomy tubes is also shown (Fig.2)

Figure 1

Figure 1: Components of the modified tracheostomy tube

Figure 2

Figure 2: A Visual Comparison Between Endotracheal Tube, Regular Tracheostomy Tube & The Modified Long Tracheostomy Tube.

This modified tube helps maintain a secure airway in patients with a very thick neck till the oedema settles or until a longer tracheostomy tube is obtained.

Correspondence to

Dr Amer Sabih Hydri Consultant ENT specialist Combined Military Hospital Peshawar, Pakistan Tel:92- 091-201-6131 Mob:92 0321 9097131 e-mail: draamerhydri@gmail.com