A Modified Endotracheal Tube Serving As A Long Tracheostomy Tube

Abstract

Tracheostomy is a life saving procedure, performed for a number of indications and on a wide spectrum of patients having a diverse anatomy of the neck. A surgeon performing tracheostomy on a patient having a large neck is always wary of the potential complications1. Often in these cases a tracheostomy tube of adequate length is not available or there is a chance of the tube getting dislodged at the slightest movement of the patient's neck causing inadequate ventilation or an obstructed airway. The scenario gets even worse if the tracheostomy tube has to be attached to a ventilator machine2. This exerts traction on the tracheostomy tube which may be yanked out of the trachea. An endotracheal tube (ETT) passed through the tracheostome provides adequate length in these patients but the extra length jutting out of the neck is not only cosmetically unacceptable3 but also restricts the neck movements of the patient . Attempts at cutting the ETT to a smaller size to fit the individual's thick neck also cuts the cuff pilot line (used to inflate the balloon and regulate pressure), which is moulded in the ETT wall. The cuff is unable to inflate and an airtight seal is not maintained thus rendering it useless in preventing aspiration and connecting with a ventilator machine. The other problem is securing this improvised ETT. An ingenious method of securing the ETT using the flange of an adjustable flange tracheostomy tube as a temporary measure4, has been described in the literature but this occasionally causes kinking of the cuff pilot line causing problem at tube replacement as the cuff cannot be deflated. I present a method of reducing the length of ETT to a suitable size while maintaining the integrity of the cuff and also a method of securing it in patients with a very thick neck.