CAUTION!
If the maximum pressure is exceeded for longer periods of time, the blood circulation
in the mucus membrane can be impaired (risk of ischaemic necrosis, pressure ulcers,
tracheomalacia, tracheal stenosis, pneumothorax). In patients undergoing artificial
respiration, the cuff pressure should not be allowed to drop below the cuff pressu-
re value specified by the doctor/physician in order to prevent unnoticed aspiration.
Hissing noises in the region of the balloon, especially during expiration, indicate that
the trachea is insufficiently sealed by the balloon. If the trachea cannot be sealed
with the pressure values specified by the doctor/physician, the entire air should be
withdrawn again from the balloon and the sealing process should be repeated. If this
does not lead to success, we recommend to use the next larger tracheostomy tube
with balloon. Due to the permeability of the balloon wall for gases, it is normal for the
pressure in the balloon to decline slightly over time, but it can on the other hand also
rise unintentionally during gas anaesthesia. Regular pressure monitoring is therefore
urgently recommended.
The cuff must never under any circumstances be inflated with excessive amounts of
air, since this can lead to damage of the tracheal wall, tears in the cuff with subse-
quent deflation, or deformation of the cuff, in which case airway obstruction cannot
be ruled out.
CAUTION!
During anaesthesia, the cuff pressure can rise/fall due to nitrous oxide (laughing gas).
2. Removing the tube
CAUTION!
Accessories such as a tracheostoma valve or HME (Heat Moisture Exchanger) must
be removed first before proceeding to remove the Fahl
CAUTION!
If the tracheostoma is unstable, or in emergency situations (puncture/dilation tra-
cheostomy), the tracheostoma can collapse after withdrawal of the tracheostomy
tube, thereby impairing air supply. A fresh tracheostomy tube must be kept ready
for use in such cases and must be quickly inserted if necessary. A tracheal dilator
(REF 35500) can be used for temporarily securing the air supply.
The cuff must be emptied before removing the tracheostomy tube. The head should
be tilted back slightly for removal of the tube.
CAUTION!
Never use a cuff pressure gauge to empty the cuff. Always use a syringe for this.
Before the air is removed from the balloon by means of a syringe and the tracheostomy tube
is withdrawn, the region of the trachea above the balloon must first be cleaned by suctioning
off secretions and mucus. If the patient is responsive and reflexes are intact, it is recommen-
ded that the patient be suctioned while at the same time unblocking the tracheostomy tube.
Suctioning is performed by inserting a suction catheter through the cannula tube into the
trachea. In this way, suctioning can be performed without any problems and gently for the
patient and cough stimulus and the risk of aspiration are minimised.
Then deflate the cuff while suctioning at same time.
If secretions are present, these are now removed and can no longer be aspirated.
Please note that prior to reinsertion, the tracheostomy tube must always be cleaned,
disinfected if necessary and lubricated with stoma oil as specified below.
Proceed very carefully to avoid injury to the mucus membranes.
Step-by-step instructions to remove the Fahl
CAUTION!
Accessories such as a tracheostoma valve or HME (Heat Moisture Exchanger) must
be removed first before proceeding to remove the Fahl
When removing the inner cannula, the following must be observed: The connection between
inner and outer cannula must first be released by slight counterclockwise rotation (in inser-
ted condition from the patient's point of view).
The inner cannula can now be removed from the outer cannula by pulling it gently.
The outer cannula (if a cuff with inflated balloon is present) remains in the tracheostoma.
tracheostomy tube.
®
tracheostomy tubes:
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tracheostomy tube.
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