Short 🧵on the Shiley XLT ('extended length') tracheostomy tube (or as I like to call it, the 'extra long trach'), which comes in 2 different types, and in particular a small but important feature of these tubes that has to be taken into account.
The Shiley XLT comes in sizes 5, 6, 7, and 8 and there are two kinds:
The more common 'proximal' XLT for patients with thick necks (L picture, top tube)
and the 'distal' XLT, for when you need a longer tube because there is an issue with the more proximal trachea (R pict)
The more common 'proximal' XLT for patients with thick necks (L picture, top tube)
and the 'distal' XLT, for when you need a longer tube because there is an issue with the more proximal trachea (R pict)
Here is the end of a 'regular' 8 Shiley tube (currently called the '8CN85H', but usually we just say '8 Shiley'.
Note that the contour is relatively smooth, facilitating insertion (the 8PERC tube (not shown) is even better).
Note that the contour is relatively smooth, facilitating insertion (the 8PERC tube (not shown) is even better).
Now here is the end of the XLT with the obturator in place (both 'proximal' and 'distal' look the same).
Note that it is not smooth at all...there is quite a stepoff and insertion of this trach tube is noticeably more difficult.
Note that it is not smooth at all...there is quite a stepoff and insertion of this trach tube is noticeably more difficult.
Once the tube is in, the difference is a non-issue. At this point the main difference (other than it being 'extended length' is that the cuffs are the traditional type whereas the new Shiley tubes have a 'TaperGuard' cuff, which is supposed to confer certain advantages.
Just to reiterate, this stepoff makes these tubes technically more challenging to place (which was the entire point of this 🧵)
If anyone has any pointers, please let the rest of us know.
If anyone has any pointers, please let the rest of us know.
Going into all the intricacies of tracheostomy tubes would require many 🧵.
For those who are interested, this is a nice resource from UC Davis with a lot of detailed information.
health.ucdavis.edu.
For those who are interested, this is a nice resource from UC Davis with a lot of detailed information.
health.ucdavis.edu.
Loading suggestions...