Intratracheal fixation

Intratracheal fixation can be achieved by means of a (fenestrated) cannula with a neck strap (LaryTube Standard or LaryTube Fenestrated), or a cannula combined with an adhesive (LaryTube with Blue Ring). When using a cannula in combination with FreeHands, a clinician should properly size the cannula to fit into the tracheostoma without leaving space between the cannula and the tracheal mucosa, in order to avoid air leakage around the cannula. When using a LaryTube with a neck strap the strap should be fitted tight enough to hold the backpressure during speaking. Using a LaryTube with a Blue Ring in combination with an adhesive might help in some patients that are having problems with maintaining the seal of the adhesive due to back pressure or due to mucous entering between the skin and the adhesive.

Another method of tracheal fixation, which does not require the use of a neck strap or adhesive, is the Barton-Mayo button. This device is trapped into the tracheostoma. This device can be used when the tracheostoma has a so-called ‘lip’ or ‘rim’ that keeps the Barton-Mayo button in place. It is usually preferred to insert it directly behind the ‘lip’ and in front of the voice prosthesis. In some patients, when the location of the voice prosthesis does not allow insertion right behind the stoma ‘lip’ it is inserted behind the voice prosthesis and the button is fenestrated to allow passage of air through the voice prosthesis. The latter is not preferred since it may cause dislocation of the voice prosthesis during insertion or removal of the button.

There are some issues that should be taken care of when applying intratracheal fixation. They are listed below.

• It is important to give proper explanation to the patient about inserting the device into the stoma and taking it out, without damaging the tracheal mucosa or dislocating the voice prosthesis. Practice a couple of times together with the patient and provide written instruction. For inserting the button the use of a forceps is advised. Fold the tracheal end of the device once and then again and use the forceps from the inside to keep it folded. Then insert into tracheostoma, release the forceps to unfold the device again.

• If the patient is complaining about a sore stoma or when there is a slight bleeding of the mucosa, try to gradually build of the use of the device (day 1 – 1 hour, day 2 – 2 hrs, etc)

• If the patient is using anti-coagulant medication and complains about bleeding of the stoma, stop using it immediately

• These intratracheal devices usually enlarge the tracheostoma, never increase the diameter of the device; instead allow shrinkage of the stoma during the night of for some days until the device fits again.

• The material of the Barton-Mayo button might become looser after sometime and cause air-leakage between the button and the FreeHands valve. Metal rings are available to keep the fit tight enough.