From the Guidelines
Yes, a Bivona tracheostomy tube can be exchanged for a long standard tracheostomy tube if there is an air leak, and this procedure should be performed by experienced healthcare professionals with proper assessment and sterile technique 1. When exchanging tubes, it is crucial to assess the patient's airway, choose the appropriate size of the replacement tube, and have equipment for emergency airway management readily available. The standard long tube may provide a better seal if the Bivona tube is causing an air leak, particularly if the leak is due to the Bivona tube being too short for the patient's tracheal anatomy. Some key considerations for the exchange include:
- Pre-oxygenating the patient
- Using a dedicated obturator to ease insertion and reduce trauma
- Assessing patency of the new tube through clinical evaluation and waveform capnography if available
- Being prepared for potential complications such as subcutaneous emphysema if the tube enters a false passage
- Considering the use of a tube one half-size smaller if the initial replacement attempt is unsuccessful, as recommended by recent guidelines 1. The decision to exchange tubes should be based on a thorough clinical assessment of the cause and significance of the air leak, as well as consideration of the patient's specific anatomical and physiological needs. It is also important to follow established protocols for tracheostomy tube management, including those outlined in multidisciplinary guidelines for the management of pediatric tracheostomy emergencies 1.
From the Research
Tracheostomy Tube Exchange
- The provided studies do not directly address the exchange of a Bivona tracheostomy tube for a long standard tracheostomy tube in the presence of an air leak.
- However, a study on chest tube removal despite an air leak or pneumothorax 2 suggests that the presence of an air leak may not be an absolute contraindication for tube removal or exchange, provided certain criteria are met.
- In the context of tracheostomy tubes, a study on expiratory airflow obstruction due to tracheostomy tubes 3 highlights the importance of considering airflow obstruction when managing tracheostomy tubes, but does not specifically address tube exchange in the presence of an air leak.
- Other studies on tracheostomy tube management, such as the impact of tracheotomy on sedative administration and patient comfort 4, and the use of lidocaine to reduce tube discomfort 5, do not provide direct evidence on the safety of exchanging a Bivona tracheostomy tube for a long standard tracheostomy tube with an air leak.
- A study on practice patterns and safety of tracheostomy tube changes 6 notes that complications, including loss of airway, can occur during tube changes, but does not specifically address the scenario of exchanging a tube in the presence of an air leak.