Custom Trachs

B.R. asks, "What if a patient needs a trach that is shorter or longer than the standard trach, because of his individual anatomy?"

Answer: A custom trach can be the answer to meet the needs of patients that cannot be met by any of the standard trachs.  Most companies offer a customized service for those patients who require something other than the standard "off the shelf" tube.

It is possible to custom order most any combination of features on a particular trach.  For example, one woman was being weaned off the ventilator and really wanted to speak.  The problem was that she had a severe anatomical defect of kyphosis, causing her trachea to be deviated into a nearly perfect "C" shape.  A standard Hyperflex tube did not work because it abutted the wall of the trachea and acted as an obstruction, so it was quickly clear that she required a custom tube.  I sent the manufacturer her CT scan and they were able to customize the curve of the tube to exactly fit the trachea.  I specified a TTS cuff, a specific length, combined with the custom curve, and it solved the problem.

Recently, I ran into a situation in which a patient could have benefitted from a trach with an inner cannula and with a TTS cuff.  As of now, there is no way to put this combination of features together as the manufacturers of the silicone tracheostomy tubes do not have inner cannulas with their high pressure, low volume cuffs.