气管切开套管型号(气管切开套管型号选择)

气管切开套管型号图片

B

气管切开套管型号字母的意思

全喉短款：内径分别为7mm-13mm。半喉长款：内径分别为7mm-11mm。半喉短款：内径为14mm。

1、全喉短款：内径分别为7mm、8mm、9mm、10mm、11mm、12mm、13mm。全喉短款的气切套管是指长度较短的套管，适用于一些特定的应用场景。内径的不同可以满足不同的需求。

2、半喉长款：内径分别为7mm、8mm、9mm、10mm、11mm。半喉长款的气切套管是指长度适中的套管，内径的选择范围较广。套管用于气切操作，适用于多种管道或器件的连接。

3、半喉短款：内径为14mm。半喉短款的气切套管是指长度较短、内径较大的套管。这套管适用于一些特殊的应用场景，要较大的内径来连接较粗的管道或器件。

气管切开套管型号与内径

气管切开的目的就是利于排痰和防止肺部感染，其实痰多不是问题，及时吸干净或者擦干净就可以，只要不是感染引起的就一切都好办！现在最重要的是要勤拍背相信你护理了这么久应该不是问题吧？还有建议做痰培养，可以了解有无感染的情况！其实最好是在医院吧，气管切开是很容易引发感染的！我们临床上用的是纯银的，它是有个内套管的需要最好4小时一次的煮沸清洗消毒，在家换还是个感染的问题，而且银质比较软一不小心会有凹陷之类怕放不进去就麻烦了，所以最好是在医院吧！

气管切开套管型号选择依据

单向阀和指示气泡。一是充气的作用，另外可以指示插管套囊的充气程度。

气管切开套管型号选择

气切塑料套管的直径？

7.0毫米、7.4毫米。经市场统计查询得知，气切套管7号等于7.4毫米。7号气切套管的型号取决于气管内径7.0毫米，外径就是7.4毫米。气管切开套管，是一种进口于土耳其的医疗用具。

气管切开套管型号选择塑料套管和金属套管

Introduction

ThewordtracheostomyisderivedfromtheGreektracheaarteria(hardartery)andtome(cut).Theprocedureconsistsofanincisioninthetrachea.Ithasbeenreportedsinceancienttimes,butitwasonlyatthebeginningofthetwentiethcenturythatitstechniqueandindicationsweredefinedanddescribedbyChevalierJackson.

Atracheostomytubeisusedtosecuretheairwayinthisprocedure,whichcanbeperformedinpatientsonprolongedinvasivemechanicalventilation,withupperairwayobstruction,undergoinglaryngectomy(喉头切除术),orathighriskofrecurrentaspiration.

Tracheostomycannulae（套管）,whencomparedwithendotracheal（气管内的）tubes,allowareductioninrespiratorywork,lesslaryngealinjury,andeasieroralhygiene（卫生）,andmayalsoenableoralfeeding.

Thereisawiderangeoftracheostomytubesavailable,withdifferentmaterials,sizes,andstyles.Onthetube’sneckplate,itscharacteristicsaremarked,suchasitsinnerandouterdiametersanditslength.Clinicians,intensivecareprofessionals,andsurgeonsmustknowthedifferencesbetweentheminordertoselectsuitabletubesforpatients’needs.

Structure

Tracheostomytubeshaveamainshaft（轴）(cannula)attachedtoaneckplate(orflange凸缘),andcuffedtubeshaveapilot（导向的）balloon,whichshowswhetherthecuffisinflated.Theneckplatehasaslot（狭槽）wheretiescanbeplaced,andfenestrated（有孔的）tubescanhaveacuffand/orinnercannula.Theirinsertionisaidedwithanobturator（密闭装置）.Figures1and2showthetracheostomytubeparts.

Materials

Tracheostomytubescanbemadefrommetal(silver银orstainlesssteel)or,mostcommonly,fromplastic(polyvinylchloride聚氯乙烯,silicone硅树脂,orpolyurethane聚亚安酯).

MetallicTubes（金属管）

Theadvantagesofmetaltubesarethattheyareendurable耐用,inert惰性,andresistanttobiofilmformation生物膜形成;theylimitbacterialgrowth;theyareeasilysanitized消毒andcanbesterilized无菌;andtheyaremorecosteffectiveforlong-termuse.Ontheotherhand,theyareinelastic无弹性的,donothaveacufforaconnectorformechanicalventilation,andcanharmthetracheabyheatorcoldinjury,hencetheyarenotsuitableforpatientsonradiationtherapywhoseradiationfieldisnearthedevice.Theyareavailablefromsize00tosize12.Figure3showsstandardmetallictubesandtheirinnercannulaefromsizes2to6.

Thetubeisinsertedwiththeaidofarounded-tipobturatorthroughitslumen;ithasaninnercannula,anditcanhavefenestration（开窗术）and/oraspeakingvalve(Figs.4,5,and6).

PlasticTubes

Plastictubescanbesemiflexible（半柔韧的）orrigid（刚性的）.Thefirsttypeadaptstothepatient’sanatomy,normallyhasarightangle,andhasalongercannula.Thesecondtypedoesnotcollapseordeflect（使弯曲）,doesnothavearightangle,andisusuallyusedforneckswelling,butitisnotsuitableforpatientswiththicknecks,sinceitsmainshaft（轴）isshort.Aswithmetaltubes,theirinsertionisaidedbyanobturator.

Polyvinylchloride（聚氯乙烯）(PVC)adjuststothepatient’stemperatureandanatomy;siliconeissoft,doesnotretainheatorcold,isresistanttocolonization（定殖）andbiofilm（生物膜）,andcanbesterilized(Figs.7,11,12,and14).

Someauthorsrecommendtheuseofplastic-cuffedtracheostomytubeswithaninnercannula,suchasBjork-ShileytubesorPortex®tubes.

CannulaTypes

Tracheostomytubesmayhaveaninnercannulaornot.Thosethatdoaredual-cannulatracheostomytubes,andthisfeatureallowsperiodic（定期）cleaningwithoutremovingthetube’smainshaftor,whenitoccludes,ensuresapatent（显露）airway.Nonetheless,thereisalackofevidencethatthishelpstopreventpneumonia,andchangingtheinnercannularegularlyincriticalcareunitsisnotnecessary.Someinnercannulaemayhaveanattachmentformechanicalventilationorfenestration（开窗术）.Figure8showscapped,conventional,and15mmadapterinnercannulae.

Ontheotherhand,aninnercannuladecreasestheinnerdiameter,resultinginadditionalworkforbreathingandparadoxical（矛盾的;  反常的）secretionadhesion（粘连）.Carteretal.evaluatedtheeffectoftheinnertubeofthePortex®BluelineUltra®ontheresistanceandworkofbreathingthroughtracheostomytubes.Itwasobservedthattheplacementoftheinnercannulasignificantlyincreasedtheworkofbreathing,andthiseffectwasgreatestwithasize7.0tube.However,thisdisadvantagemustbeweighedagainstthebenefitsofcleaning,andencrusted（包外壳的）secretionsmayalsoreducetheinnertubediameter.Figure9showsthedifferenceintheinnerdiametersofplasticcannulaewiththesameouterdiametersizebutwithandwithoutaninnercannula.

Asinglecannulapreventsanincreaseintheworkofbreathing,butitisnotsuitableforpatientswithexcessivesecretionsorpoorclearing.

Dimensions（尺寸）

Thespecificationsoftracheostomytubesarerelatedtothedimensionsoftheirlength,curvature（曲率）,andinnerandouterdiameters.Thesedimensionsarenotstandardized;differentmanufacturers’tubesizesarenotequivalenttoeachother,andthesizeusuallycorrespondstoneithertheinnernortheouterdiameter.Hence,differenttubebrandswiththesamesizenumbersmightactuallybequitedifferent.Thesizeandtheinnerandouterdiametersareusuallymarkedontheneckplateofthetracheostomytube(seeFig.10).

TheInternationalOrganizationforStandardization(ISO)hasdeterminedasizingmethodbasedontheinnerdiameteroftheoutercannulaatitssmallestdimension.Dual-cannulasizingconsiderstheinnercannulaasthefunctionaldiameterandtheouterdiameterasitslargestdiameter(Table1).

I.D.innerdiameter,NAnotavailable,O.D.outerdiameter

Withregardtotubelength,tubesmaybeangled,standard,extra-length,oradjustableflange（凸缘）.Forpatientswithlargenecks,long-flangetubesarenecessary,andadjustable-flangetubesenableschangingthetube’slenghtwhennecessary—forinstance,whenthereisgranulation（肉芽）tissueoratumorwithintheairwayorbetweentheskinandthetrachea.Figures11,12,and13showthedistinctionsinthecurvatureandlengthoftracheostomytubes.Thelockingdevicemustbesecuredsothetubewillnotbedislodged（移出）ormoveoutofposition.InFig.14,anadjustablePortex®lockingdevicemechanismisdemonstrated.

Whenchoosingthetracheostomytubesize,somefactorsmustbeconsidered,suchasthesizeofthepatient’sneck,thestoma（造口）andtracheasize,thepresenceoftumorsorgranulationtissue,thequalityandquantityofsecretions,andventilatorandweaningneeds.Iftheinnerdiameteristoosmall,theresistancethroughitandrespiratoryworkwillbeincreased,andthecuffpressurerequiredtosealthetracheallumenwillbehigher.Alargeouterdiameterpreventsthepatientfromspeakingwhenthecuffisdeflated.Figure15showsaschematicdrawingofthedifferencebetweeninnerandouterdiametersizes.

Thetracheainadultfemaleshasasmallerinnerdiameterthanthatinmales,andtubeswitha6.0–6.5mminnerdiameter(10mmouterdiameter)areusuallyadequateforfemales,whiletubeswitha7.0–8.0mminnerdiameter(11mmouterdiameter)aresuitableformales.Inchildren,thediameterofthefifthfingerissimilartothetracheasize.

Fenestration

Fenestratedtubeshaveanopeningontheposteriorwallofthecannula,whichallowstheairtoflowandbeexhaledthroughit.Thisopeningmayconsistofonelargeopeningorseveralsmallones.Adual-cannulatubemayormaynothaveafenestratedinnercannulaandmaybecuffedorcuffless.Figure16showsexamplesofmetallictubesize3,4,5,and6fenestratedcannulae.

Thisfeatureisimportantforpreparingthepatientfordecannulation（拔管）andphonation（发声）.Whenitisplugged（堵塞）andthecuff(ifpresent)isdeflated,theairflowstotheupperairwaythroughthisopeningandaroundthecannula.Thismakesitpossibletoassessthepatient’sabilitytobreatheusingtheupperairway,andallowsphonation.Whenthepatientisusingacuffedtube,itmustbedeflatedbeforeoccludingthecannula.Afenestratedtubemodel,showingitsinnercannulaandcap,isshowninFig.17.

Thesetubesmaybedifficulttofit,andthedistancefromtheneckplatetothefenestrationshouldbe1cmlongerthanthestoma（造口）tractlengthforbetteradaptation.Otherwise,theairwillnotpasstotheupperairwayandtherewillbeanincreaseinflowresistance.Despitecorrectpositioning,theremaybeotherproblems—suchasgranulationtissueinducedbythefenestrations,resultinginimpairmentoftheairway—andthepositionofthefenestrationsshouldbecheckedperiodically.

CuffedandCufflessTracheostomyTubes

CuffedTubes

Tracheostomytubesmaybecuffedoruncuffed(cuffless).Thecuffisaroundeddilatationlocatedinthedistalpartofthecannula,whichsealstheairway,providingaclosedsystemforairwayprotectionandventilation.Therearehigh-volumelow-pressure,low-volumehigh-pressure,andfoam（泡沫）cuffs.

High-volumelow-pressurecuffsarethemostcommonlyusedtype.Theyhavealargediameterandalargeresidualvolume,sotherestingvolumeislargerthanthepatient’strachealdiameter,andthethinflexiblematerialofthewalladaptseasilytothetrachealwallwheninflated.Nonetheless,ifexcessivepressureisappliedtothetrachealwall,theremaybedamagetoitsmucosa.

Thecuffpressuresusedincurrentstandardpracticerangefrom20to30cmH20(15–22mmHg)toprovidesealingoftheairwayandtopreventaspiration,preventingdamagetothetrachealwall.Monitoringoftheintracuffpressureshouldbeperformedatleastoncepershiftandmoreoftenifnecessary(e.g.,ifaleakoccurs,ifthepositionorthetubearechanged,orifthevolumeofairischanged).Besidestheriskoftrachealwallinjury,highercuffpressureimpairstheswallowingreflex（削弱吞咽反射）.

Highpressureiscommonlycausedwhenthetubeissmallandthecuffmustbeoverfilledinordertosealthetrachea,orbytubemalpositioning（错位）,low-pressurehigh-volumecuffs,andtrachealdilatation.

Alow-volumehigh-pressurecuffissuitableforpatientsreceivingintermittent（间歇的）cuffinflation,becauseitallowstheairtoflowaroundthetubewhiledeflated,sospeechandupperairwayusearepossible.Itisasiliconecuff,whichshouldbefilledwithsterilewater,becauseifitisinflatedwithair,itwilldeflateduetogaspermeability（气体渗透性）.Figure18compareslow-volumehigh-pressurecuffsandhigh-volumelow-pressurecuffs,demonstratinghowthosecuffsinteractwiththetrachealwall.

Foamcuffsarenotcommonlyused;theycontainautoexpandingfoamcomposedofpolyurethanefoam（聚氨酯泡沫塑料）coveredbyasiliconesheath,whichconformstothepatient’sairwayshape.Thesecuffsinflatepassivelyatambientatmosphericpressureand,ifusedproperly,thispressurewillnotexceed27cmH20(20mmHg).Theirinsertionandremovalareharder,andtheairshouldberemovedwithasyringe,whichisdisconnectedwhenthetubeisinplace.Thepilottubeisopenedandthecuffkeepsitspressurebalancedwiththeatmosphericpressure(observeinFig.19theBivona®tubedeviceforcuffinflationcontrol).Nonetheless,theyhavetobe periodicallydeflatedsothathumidity（湿度）isremovedfromthesponge（海绵）andtokeepthesiliconesheathfromadheringtothetrachealwall.Theyarenotsuitableforpatientswithone-wayspeakingvalves,sincetheysealthelowerairway,andsotheyarereservedforpatientswithtrachealinjurycausedbycuffedcannulae.

Cuffs,eitherdeflatedorinflated,mayincreasetheworkofbreathing,andtheyshouldbereplacedwithacufflesstubewhilethepatientisintheprocessofweaning.

Somecuffedtracheostomytubeshaveasuctionportabovethecufftoremovesubglotticsecretions.Theirroleinpreventingventilator-associatedpneumonia(VAP)inpatientswithendotrachealtubeshasbeenshowninmeta-analyses,withareductioninVAPofapproximately50%.Ledgerwoodetal.alsoobservedfewercasesofVAPandtrendstowardreductionsintheintensivecareunitstayandthetimeofmechanicalventilationinpatientswithatracheostomytubeandasubglotticsuctionport.Nonetheless,therehavebeennolargeclinicaltrials,normeta-analyses,onsubglotticsuctiondevicesintracheostomytubes.AtracheostomytubewithasuctionportisshowninFig.20,withitspathhighlightedanddistalportmagnified.

CufflessTubes

Cuffless(uncuffed)tracheostomytubesallowairtoflowtotheupperairwayandallowstomal（人造口周围的）maintenance.Theyareusedwhenmechanicalventilationisnolongerrequiredbuttheairwaysstillneedtobeaccessed.Thereareplasticandmetalmodelsavailable.Figure21showsplasticandmetallicuncuffedtubes.

Somefactorsmustbeaddressedbeforeacufflesstracheostomytubeisused.Firstthepatienthastobeabletobreathespontaneouslyandswallow（吞咽）withoutsignificantaspiration.Oncethepatientisfittedwiththecufflesstube,itsopeningcanbeclosedwiththepatient’s(orcaregiver’s)finger,becapped,oraspeakingvalvecanbeusedforspeech.

Plasticuncuffedtubesareusedinpatientsreceivingheadandneckradiotherapytopreventstomaandtrachealwallburn.

TracheostomyTubeSizes

ThesizingchartsshowninTables2,3,4,5,6,7,8,9,and10areadaptedfromtheAustinHealthTracheostomyReviewandManagementService(TRAMS)tracheostomysizingchart(seealsoFigs.22,23,24,25,26,27,28,29,30,31,32,and33).

Conclusion

Thereisawiderangeoftracheostomytubesavailablefordifferentclinicalsettings.Theclinicianmustbefamiliarwiththemtochooseasuitabletubeforeachpatientandoccasion.