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FAQs

1.  What sizes of the Blom Tracheostomy Tubes are available?

2.  How long can the Blom Tracheostomy Tubes, Standard, Fenestrated, Subglottic Suctioning, Speech Cannula and LPV be used?  

3.  How does the fenestration on the Blom Tracheostomy Tubes differ from fenestrations found on other brands of tracheostomy tubes?

4.  Is the Blom Trach compatible with the Ciaglia Blue Rhino® Percutaneous sets and trays by Cook® Medical

5.  How does the Subglottic Suctioning Cannula Work?

6.  If my Subglottic Suctioning Cannula becomes occluded, what do I do?

7.  How do you distinguish the Speech Cannula from the LPV?

8.  How does the Speech Cannula Work?

9.  Which patients ARE appropriate candidates for the Speech Cannula?

10. Which patients are NOT appropriate candidates for the Speech Cannula?

11.  How long after placing a Blom Tracheostomy Tube should practicioners wait to attempt the Blom Speech Cannula?

12.  How do you assess upper airway patency when using the Blom Speech Cannula?

13.  How long can a patient use the Blom Speech Cannula? 

14.  Does the Speech Cannula make it more difficult for the patient to breathe?

15.  What ventilator settings should be changed to facilitate patient tolerance of the Blom Speech Cannula or alarm management?

16.  Does the Speech Cannula impact Peak Inspiratory Pressures? 

17.  What is the potential risk for secretion aspiration with the Blom Speech Cannula?

18.  What should a clinician consider when determining patient candidacy for swallowing treatment and oral intake?

19. Can you leave the HME inline while using the Speech Cannula? 

20. How is PEEP affected during Speech Cannula use? 

21. When using the LPV with the Blom Fenestrated Cuffed Tracheostomy Tube, does the cuff need to be fully deflated? 

22. How does the LPV differ from other brands/traditional speaking valves? 

23. What is the resistance of the flap valve on the LPV? 

24. How are secretions mobilized when using the Speech Cannula and/or LPV? 

25. How should the Speech Cannula and LPV be cleaned? 

26. How does the EVR™ (Exhaled Volume Reservoir) work? 

27. Where should the EVR be placed (or inserted)? 

28. How long can the EVR be used? 

29. Is there additional “dead space” as a result of using the EVR? 

 

 

1.  What sizes of the Blom Tracheostomy Tubes are available?

Blom Tracheostomy tubes are available in sizes 4, 6, 8, and 10, and are available in 3 styles: cuffed fenestrated, uncuffed fenestrated, and uncuffed non-fenestrated.  

 

2.  How long can the Blom Tracheostomy Tubes, Standard, Fenestrated, Subglottic Suctioning, Speech Cannula and LPV be used? 

  • The Blom Tracheostomy Tubes should be exchanged every 30 days.

  • The Standard and Subglottic Suctioning Cannulas should be exchanged every 24 hours or per facility protocol.

  • The Speech Cannula and LPV™ (Low Profile Valve) should be exchanged every 60 days.

 

 

 3.  How does the fenestration on the Blom Tracheostomy Tubes differ from fenestrations found on other brands of tracheostomy tubes? 

  • The fenestration on the outer cannula of the Blom Tracheostomy Tube has smooth rounded edges unlike fenestrations found on traditional tracheostomy tubes. The fenestration is located 1mm above the cuff, closer to the distal portion of the tube. This design further reduces the potential for the fenestration to contact the tracheal mucosa.

  • The Blom fenestration is larger than most traditional fenestrations which reduces airflow resistance during respiration.

  • The Blom fenestration is separated by a bar to prevent a suction catheter from entering the fenestration during deep tracheal suctioning. This protective bar helps guide the suction catheter along the lumen of the outer cannula so the catheter can safely by passed into the lower airway.

 

 

 

4.  Is the Blom Trach compatible with the Ciaglia Blue Rhino® Percutaneous sets and trays by Cook® Medical? 

Yes, it can be used with the same Blue Rhino kits that are used for Shiley® Tracheostomy Tube placement. 

 

5.  What should I do if the Subglottic Suction Cannula becomes clogged with secretions?

  • The Blom Subglottic Suctioning Cannula contains a separate lumen attached to the outside of the inner cannula which originates at the level of the fenestration just above the cuff. Secretions that accumulate above the cuff can be removed with low continuous suction at 20mm – 30mm Hg. Intermittent suction, or suctioning with a regulator capable of timed on/off cycles can be completed at 100-150 mm Hg. The secretions will be suctioned through the fenestration, into the suction line and deposited in the suction canister at the bedside.

  • All four Subglottic Suctioning Cannula sizes have space for adequate airflow to pass for respiration and for a suction catheter to be passed through the inner cannula for deep tracheal suctioning. Deep tracheal suctioning may still be performed as needed using an inline or disposable single use suction catheter when the Subglottic Suctioning Cannula is in place.

 

 

6.  If my Subglottic Suctioning Cannula becomes occluded, what do I do? 

The Subglottic Suctioning Cannula should be changed every 24 hours. If it becomes occluded prior to that, remove the cannula, flush it with sterile water or saline and reinsert it. If the mucous cannot be cleared replace it with a new Subglottic Suctioning Cannula. 

 

7.  How do you distinguish the Speech Cannula from the LPV? 

  • The Speech Cannula is a full length cannula with a pink 15mm hub connector to hook up to a ventilator circuit. It contains the Flap and Bubble Valves.

  • The LPV is a “short” cannula with a Flap Valve at the distal end. This lower profile valve does not have a 15mm hub; therefore, it cannot accidentally be connected to a ventilator circuit.

Reminders:

  • Speech Cannula:

The Speech Cannula is designed to be used only in conjunction with the Blom Fenestrated Cuffed Tracheostomy Tube.

The patient must be ventilator dependent.

  • LPV:

The LPV can be used with the Blom Fenestrated Cuffed, Fenestrated Uncuffed or the Non-Fenestrated Uncuffed Tracheostomy Tubes.

The LPV is intended for non-vented, spontaneously breathing patients only.

 

8.  How does the Blom Speech Cannula work? 

The Blom Speech Cannula has two unique valves that re-direct air allowing ventilator dependent patients to phonate with a fully inflated cuff. 

  • During inhalation the Flap Valve opens and the Bubble Valve expands into the fenestration to seal it, preventing air from escaping into the upper airway. 

  • During exhalation the Flap Valve closes and the Bubble Valve collapses to unblock the fenestration, letting air flow up through the fenestration to the vocal cords allowing phonation.

 

9.  Which patients ARE appropriate candidates for the Speech Cannula? 

Those who:

  • Are ventilator dependent on a standard or portable ventilator

  • Have a Blom® Fenestrated Cuffed Tracheostomy Tube

  • Weigh >30k (66lbs)

  • Are responsive and have the potential to communicate

  • May be in volume or pressure ventilation in any ventilator mode

  • Have a patient, unobstructed upper airway

Additionally:

  • Patients do not need to be breathing spontaneously

  • Patients do not need to be able to tolerate cuff deflation

 

10. Which patients are NOT appropriate candidates for the Speech Cannula?

Those who:

  • Have specific anatomical or airway concerns which necessitate the use of an extra-long, custom, or foam cuffed tracheostomy tube which cannot be replaced with a standard tracheostomy tube

  • With known lower or upper airway obstruction including stenosis, tracheomalacia, granulation tissue, or vocal cords paralyzed in the adducted position

  • Have an excessively dilated tracheostomy stoma that results in air escape around the tracheostomy tube at the stoma site

  • Have copious, thick secretions requiring suctioning more than five times per hour

  • Require PEEP>10 or an Fi02 greater than 60

 

11.  How long after placing a Blom Tracheostomy Tube should practitioners wait to attempt the Blom Speech Cannula? 

  • When the Blom Tracheostomy Tube is initially placed during the surgical tracheotomy, use of the Blom Speech Cannula should be delayed approximately 3-5 days until the physician believes that the fresh surgical tracheostomy site is sufficiently healed.

  • Patients who have an established tracheostomy site and convert to a Blom Tracheostomy Tube should wait at least 30 minutes and only after vital signs have returned to normal post tracheostomy tube change before using the Blom Speech Cannula. If resistance was encountered during the tracheostomy change, or bleeding occurs, practitioners may elect to wait longer for potential swelling and airway irritation to subside. 

 

12. How do you assess upper airway patency when using the Blom Speech Cannula? 

  • Once the Blom Speech Cannula has been placed, immediately verify airflow in the upper airway using these methods:

  • Listen for exhaled airflow at the patient’s mouth

  • Ask the patient to forcibly exhale and feel for airflow from the nose and mouth

  • Ask the patient to phonate. The patient’s vocal quality should NOT be strained, as this may indicate insufficient airflow through the vocal cords

  • Listen for airflow using a stethoscope at the upper airway

  • Ensure that the high pressure alarm is not sounding

 

13.  How long can a patient use the Blom Speech Cannula?     

The Blom Speech Cannula should initially be used for short periods of time and can be increased with patient tolerance. The Blom Speech Cannula must always be “used under Qualified Supervision Only” of a healthcare practitioner or caregiver who has been trained in the utilization and safety precautions regarding the Blom Speech Cannula. An interdisciplinary approach is recommended within inpatient facilities to maximize the time that a patient may use the Speech Cannula with supervision. 

 

14.  Does the Speech Cannula make it more difficult for the patient to breathe? 

Work of breathing can be influenced by many factors including the restoration of airflow through the upper airway, the presence of mucous obstructing airflow, lung compliance, circuit compliance, ventilator settings, medical status, and underlying respiratory diseases. The taper at the distal end of the Speech Cannula causes an increase in resistance at that level, however, this is not realized as increased resistance once the gas reaches the lungs. Ventilator adjustments may facilitate improved patient comfort. Refer to the Blom Tracheostomy Tube Ventilator Tips for more information. 

 

15.  What ventilator settings should be changed to facilitate patient tolerance of the Blom Speech Cannula or alarm management? 

Changes may include:

  • Increasing the high pressure alarm during volume ventilation to compensate for the negligible restriction to gas flow when air is delivered during inspiration through the Flap Valve

  • Reducing inspiratory time or increasing peak flow to extend the expiratory phase and decrease the likelihood of air trapping

  • In the event of auto-triggering, adjust sensitivity to make the ventilator less sensitive until auto-triggering ceases

  • Refer to the Blom Tracheostomy Tube Ventilator Tips for more information

 

16.  Does the Speech Cannula impact Peak Inspiratory Pressures? 

When using the Speech Cannula in pressure control, PIP will not increase because the target pressure is the maximum pressure achieved. When using the Speech Cannula in a volume control mode, it is normal to see a 5-10 cm H20 increase in PIP as the gas is pushed through the flap valve. However, intrapulmonary pressure will remain essentially unchanged. An increase in PIP of more than 10 cm H20 in volume ventilation may be indicative of air trapping. The Speech Cannula should be removed, inspected and rinsed in saline. Repeat suctioning, consider re-positioning the patient and/or ventilator setting adjustments, and re-attempt the Speech Cannula. If continued air trapping occurs, practitioners may also consider partially or completely deflating the cuff in order to reduce airflow resistance. If continued air trapping persists, discontinue trials and consider endoscopy to rule out airway obstruction. 

 

17. What is the potential risk for secretion aspiration with the Blom Speech Cannula?

In addition to suctioning the trachea and velum, clinicians should always use the Blom Subglottic Suction Cannula prior to inserting the Speech Cannula. Patients using the Blom Speech Cannula are not at any increased aspiration risk when the cuff remains inflated. During exhalation, secretions that lie above the cuff will be more likely to be expectorated orally since the exhaled airflow will pass through the fenestration, upper airway, and be expelled through the nose and mouth. This air movement may allow for enhanced clearance of upper airway secretions. 

 

18.  What should a clinician consider when determining patient candidacy for swallowing treatment and oral intake? 

Considerations include the patient’s age, mental status/alertness, physiologic parameters, diagnosis, duration intubated prior to trach placement, duration tracheostomized, past medical history/co-morbidities, level of deconditioning, secretion quantity and viscosity, cough strength, oral motor strength and function, and the length of time that has passed since the patient was eating and drinking by mouth.

 

When oral intake is attempted with a ventilated patient, use of the Speech Cannula may be helpful due to the restoration of subglottic airflow, and potentially improved expectoration, airway protection and laryngeal sensation. The Clinician will also be able to assess vocal quality post-swallow.

 

Swallow assessments should be completed based on facility protocol, however, a thorough assessment inclusive of an instrumental examination (MBSS or FEES) is recommended due to the medical complexity of these patients.

 

Use of the Subglottic Suction Cannula to check for the presence of aspirated material above the cuff is extremely helpful during “Bedside” assessments and Modified Evans Blue Dye tests. 

 

 

19. Can you leave the HME inline while using the Speech Cannula? 

Yes, the HME can be left inline while using the Speech Cannula, but it does not provide any heat/humidity while the Speech Cannula is in use since exhaled air passes out through the patient’s nose and mouth rather than back through the HME and ventilator circuit. 

 

 

20. How is PEEP affected during Speech Cannula use? 

PEEP is maintained on most conventional ventilators.

 

 

21. When using the LPV with the Blom Fenestrated Cuffed Tracheostomy Tube, does the cuff need to be fully deflated? 

Because the Blom Cuffed Tracheostomy Tubes are Fenestrated, patients with a partially or fully inflated cuff can exhale through the fenestration of the tracheostomy tube without having the cuff deflated. Patients should be assessed carefully by the clinician, who should confirm upper airway patency/airflow. Deflating the cuff while the LPV is in use will decrease airflow resistance. 

 

 

22. How does the LPV differ from other brands/traditional speaking valves?

The Speech cannula and LPV are made of silicone and have indwelling flap valves that open during inspiration and close during expiration. Deep tracheal suctioning can be performed through them.  Both the Speech Cannula and LPV can be left in place during breathing treatments without disrupting flap function.  Finally, the LPV is lower profile:  it protrudes less distance from the patient’s neck and may allow for improved range of motion, especially during a “chin tuck” swallow maneuver.

 

 

23. What is the resistance of the flap valve on the LPV? 

1 cm H20

 

24. How are secretions mobilized when using the Speech Cannula and/or LPV?  

When using the Speech Cannula or LPV with the cuff inflated, patients can expectorate secretions that have accumulated above the cuff more effectively, and  deep tracheal suctioning may still be necessary to manage lower airway secretions.  When using the Speech Cannula or LPV with the cuff deflated, patients will have greater potential to mobilize secretions from the lower airways as well. 

 

 

25. How should the Speech Cannula and LPV be cleaned? 

Daily Intermittent use, the Speech Cannula and LPV should be rinsed with warm water or saline solution immediately after the removal from the Tracheostomy Tube and allowed to thoroughly air dry before using again. **Do not apply heat to dry.

 

​Storage:

When removing for storage, swish the Speech Cannula or LPV in pure, fragrance-free soap and warm (not hot) water

Rinse the Speech Cannula or LPV thoroughly in warm running water

Allow to air dry thoroughly before placing in the storage container. **Do not apply heat to dry.

DO NOT USE HOT WATER, PEROXIDE, BLEACH, VINEGAR, ALCOHOL, BRUSHES OR COTTON SWAPS TO CLEAN THE SPEECH CANNULA OR LPV.

 

 

26. How does the EVR™ (Exhaled Volume Reservoir) work?  

The EVR helps to negate the obligatory low volume alarms which occur during Speech Cannula use when exhaled air is redirected through the upper airway instead of back to the ventilator. During inspiration, a small portion of gas (30-50ml) expands the EVR bellows. During exhalation, the bellows contract, and the volume of gas is returned to the ventilator for measurement. The EVR is useful with many ventilators in conjunction with reducing low minute and tidal volume alarm parameters, but it is not needed with all ventilators. Consult the Blom Ventilator Tips, or view the Blom ventilator videos for further information pertaining to specific acute care and home ventilators. 

 

27. Where should the EVR be placed (or inserted)?  

  • For ventilators that measure volume machine; Install the EVR at the end of the expiratory limb of the circuit just prior to the exhalation inlet port.

  • For volumes which are measured through a proximal flow sensor: Install the EVR between the flow sensor and the patient. 

 

 

 28. How long can the EVR be used?    

The EVR should be removed from the ventilator circuit when the Speech Cannula is removed from the patient. It should be replaced when the entire ventilator circuit is changed, or according to local established protocols. 

 

 

29. Is there additional “dead space” as a result of using the EVR? 

The EVR will impose approximately 30-50 ml of dead space if left inline adjacent to the proximal flow sensor when the Speech Cannula is not in use.