Which Trache Tube?

14th April 04
Hi
I was wondering about the different hospitals preferences with the use of the Portex Tracheostomy vs. the Shiley Tracheostomy and the reasons why?

Level 5 (JFICM 2)

14th April 04
I'd be interested in replies to this too - I have always disliked the stiff plastic and the bayonet fitting for the inner cannulae on the Shiley, and I am thinking of switching MWAHS to Portex for these reasons. The subglottic suction option is also only available on Portex at present I understand...

Director of Intensive Care, Rural Level 5
Area Director of Critical Care Services, Mid Western Area Health Service

14th April 04
At RPAH we switched to the Portex about 18months ago. There has been no problem with functionality of the tracheostomy tubes fen or non-fen, the level of educational/clinical support from Boots (they make the portex) is excellent, the subglottic suction option is available, the percutaneous tracheostomy introducer sets (Ultraperc) have a tube included making them cost effective compared to all of the components required for a perc using the Cook brand and the medical staff liked the Portex perc sets because of an improved introducer.
The only issues we had were:
1. the labeling of the tubes to distinguish fenestrated vs non-fenestrated needs to be improved - it is not clear - the company is aware but no action as yet
2. there were some concerns regarding the lubriciousness (new word from Portex meaning slippery!) of the introducers in the perc sets but this is over come by the technique.
I would suggest contacting Boots and asking for Jane Lytwyn to come and see you if possible - she is one of their rep's and is excellent.

Statewide Coordinator,
Critical Care Services Planning NSW Health Department

15th April 04
Liverpool hospital switched to portex blueline when they were first introduced This negated the necessity of a tube change prior to patient transfer to the ward. The wards at Liverpool do not take trache tubes with no inner cannula. Shiley tracheys are rarely used now. I agree with Brett, contact Jane Lytwyn from Boots, Jane's after sales and education services are
excellent

Equipment Coordinator Tertiary Referreal ICU

15th April 04
We switched about 2 years ago when portex finally made a decent percutaneous trache kit that worked. We never liked the stiffness of the Shiley, and it used to be one of the disadvantages of perc trache.

Director Level 6

18th April 04
Treena, the answer is a bit more complex than 'Portex' vs 'Shiley'. It comes down to at least three things, ie materials, range of options, and price, as well as your interpretation of the subglottic suction literature (reasonably strongly positive but not rock solid).
1. Price is the easiest - the good old Shiley (Mallinkrodt) tubes are the cheapest. From memory, [give or take $10 depending on how well you negotiate] you are looking at about $50 vs between $70 and $90 per tube. Need to also look closely [if you are a believer in coaxial tubes (ie with inner cannulae)] whether your quoted price includes the inner cannula or if that wil cost you more, and whether you are talking about subglottic suction tubes or standard tubes.
2. Materials. The hard plastic of the 'good old Shiley' is a major problem. Initially the strongest selling point of the Protex Blueline range was the new thermoplastics being used. Other companies are now coming on board and Mallinkrodt are now starting to roll out their Shiley TracheoSoft range (think 'new Shiley') which equals the benefit of the Portex Blueline. It's a little while since I spoke to the Mallinkrodt rep and I don't know how expensive the TracheSoft tubes are going to be.
3. Range of tubes. Traditionally the biggest selling point of the Shiley range. They still have some features which are not matched in other ranges. I have on my desk a Shiley TracheoSoft XLT (extra long proximal extension, and they also have one with extra long distal extension), specially designed for fatties and much better than the 'good old Portex' adjustable flange tubes. For most purposes either brand will suit you. Don't forget also the place of specialist tubes such as the Bivona FomeCuff which I use about once a year but really need it when I need it!!
4. Subglottic suction. This almost warrants a monograph in its own right. The concept was invented by Mallingkrodt in the form of the Evac tracheostomy tube but took a while to catch on. The Evac is not coaxial. The Portex Blueline Suctionaide was the first really good tube for this purpose, which includes two inner cannulae for believers, and also has a wire channel up the obturator which makes percutaneous tracheostomy with it really easy. We adopted these routinely for all ICU tracheostomies about a year ago. My NUM doesn't like it (as this is the most expensive tracheostomy option) but the physios love the tubes.
Don't forget the evidence base for subglottic suction, though. The four PRCTs all looked at early use of subglottic suction, in the first days after intubation, and if you only adopt subglottic tracheostomy tubes you are not actually following the evidence. There is only one long ETT with a subglottic suction channel, the Mallingkrodt Evac. We use these for all intubations in the ICU and it is the only tube on our intubation trolley. I don't the risk / benefit equation supports routinely changing the tubes of patents who arrive pre intubated, however. Again cost is an issue - as a low volume item the long Evac tubes are about $15 [rough figures] whereas a Portex HiLo tube on government contract is about $3. Beware also if you follow this path, the suction channel impinges on the inner lumen and it is difficult to fit a 5mm OD bronchoscope through a 7mm ID Evac tube.

Staff Specialist Tertiary Referral

20th April 2004
At XXX we trialed the Portex and found that they were difficult to clean especially if the sputum was tenacious. We also found that on the wards where nurses have more than one patient to care for, the cleaning (shaking the inner cannula in saline as advised by the rep) was too time consuming. Therefore often not being done properly. In ICU we also found that the ring pull attachment came off at times and we found that the trache became disconnected very easily from the ventilator tubing. Consequently we have stayed with the Shileys when the patients are sent to the wards.
Whilst in ICU we use the single lumen Mallinkrodt and have no problems with disconnection, ventilation and cleaning. Shileys also have a tube with subglottic suction.
CNC Tertiary Referral