Clinical use and material wear of polymeric tracheostomy tubes.
OBJECTIVE
The objectives were to compare the duration of use of polymeric tracheostomy tubes, i.e., silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU), and to determine whether surface changes in the materials could be observed after 30 days of patient use.


METHODS
Data were collected from patient and technical records for all tracheostomized patients attending the National Respiratory Center in Sweden. In the surface study, 19 patients with long-term tracheostomy were included: six with Bivona TTS Si tubes, eight with Shiley PVC tubes, and five with Trachoe Twist PU tubes. All tubes were exposed in the trachea for 30 days before being analyzed by scanning electron microscopy (SEM) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR). New tubes and tubes exposed in phosphate-buffered saline were used as reference.


RESULTS
Si tubes are used for longer periods of time than those made of PVC (P<.0001) and PU (P=.021). In general, all polymeric tubes were used longer than the recommended 30-day period. Eighteen of the 19 tubes exposed in patients demonstrated, in one or more areas of the tube, evident surface changes. The morphologic changes identified by SEM correlate well with the results obtained by ATR-FTIR.


CONCLUSIONS
Si tracheostomy tubes are in general used longer than those made of PVC and PU. Most of the tubes exposed in the trachea for 30 days suffered evident surface changes, with degradation of the polymeric chains as a result.
Björling
Gunilla
G
Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, National Respiratory Centre, and the Sophiahemmet University College, Stockholm, Sweden. gunilla.bjorling@sophiahemmethogskola.se
Axelsson
Sara
S
Johansson
Unn-Britt
UB
Lysdahl
Michael
M
Markström
Agneta
A
Schedin
Ulla
U
Aune
Ragnhild E
RE
Frostell
Claes
C
Karlsson
Sigbritt
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D011108:Polymers; D011140:Polyurethanes; D011143:Polyvinyl Chloride; D012042:Registries; D012826:Silicone Elastomers; D017550:Spectroscopy, Fourier Transform Infrared; D013499:Surface Properties; D013997:Time Factors; D014139:Tracheostomy / Q000295:instrumentation
D011108:Polymers; D011140:Polyurethanes; D012826:Silicone Elastomers; D011143:Polyvinyl Chloride