The Blom Tracheostomy Tube System

(Pulmodyne, Indianapolis, Indiana)

Presented by Tara C. Quin

The Blom Tracheostomy Tube

● The Blom Tracheostomy Tube System is intended to provide tracheal access for airway management of adult tracheostomized patients.

● Benefits○ Airway protection○ Subglottic suctioning○ Communication

Types of Blom Tracheostomy Tubes

● Fenestrated Cuffed Tracheostomy Tube○ Ventilator dependent patients

● Non Fenestrated Uncuffed Tracheostomy Tube○ Spontaneously breathing patients

The Blom Fenestrated Cuffed Tracheostomy Tube

● Modified fenestrated outer cannula ○ Fenestration is located approximately 1mm from cuff○ Cuff inflation prevents fenestration contact with the

tracheal mucosa○ Rounded, smooth edges of fenestration helps prevent

granulations

Neck Plate ● Imprinted:

○ Manufacturer or product name

○ Size○ Inner Diameter (ID) &

Outer Diameter (OD) of cannula

Unique Telephone Jack Clip Feature

● Secures inner cannula to the outer cannula● Distinct “click” to ensure cannula is locked in

place● Minimal effort to secure the cannula

Current Methods of Securing Inner Cannula● Requires a quarter-turn of a screw

mechanism● Difficult to connect and disconnect inner

cannulas○ Patient discomfort is a common complaint

Blom Inner Cannulas

● Subglottic Suctioning Cannula

● Speech Cannula● LPV (Low Profile

Valve)

Blom Subglottic Suctioning Cannula● Provides secretion management for trach patients● Small suction line on the outer surface of the inner

cannula● Suction line terminates at the lower portion of the

fenestration, directly above the cuff

Current subglottic suctioning tubes:

● Suction line is on the exterior of the outer cannula● Difficult and uncomfortable for patient● Blockage requires complete change of

tracheostomy tube● Flush while still in airway is not an approved

practice by some manufacturers

Blom Subglottic Suctioning Cannula● Continuous low suction ● Suction on high flow applied

intermittently using a suction regulator capable of intermittent, timed on/off cycles.

● Can be attached to an air source to verify the upper airway patency of patient prior to use of speech cannula

Blom Speech Cannula● Used only with Blom Fenestrated

Cuffed Tracheostomy Tube● Intended for respirator dependent

patients● No cuff deflation required

○ Diminished risk of aspiration● Bubble Valve near fenestration● Flap Valve at lower end of inner

cannula tube

How it Works● Inhalation

○ Bubble Valve expands and Flap Valve opens○ Air delivered to lungs

● Exhalation○ Flap Valve closes and Bubble Valve collapses○ Air goes through fenestration to vocal cords○ Phonation

Recap of Speech CannulaBenefits● Decreased risk of aspiration since cuff remains inflated● Vocalization takes place during exhalation

○ More natural speech● Allows patients who cannot tolerate cuff deflation the

ability to vocalize● Helps to maintain subglottic pressure

○ May assist in swallowing and secretion management

Exhaled Volume Reservoir (EVR)● Prevents the occurrence of “false” low

expiratory minute volume alarms which occur when the Blom Speech Cannula is in use and air is redirected through the upper airway during exhalation (vs back to ventilator)

● Compatible with most positive pressure ventilators

Blom Low Profile Valve (LPV)

● Speaking Valve● Use with Blom Non-Fenestrated Uncuffed

or Fenestrated Cuffed tubes● One-way valve● Fits in outer cannula● For non-ventilator dependent patients● Cuff may be inflated, partially deflated, or

fully deflated○ Does NOT require cuff deflation

● Low profile

Current Speaking Valves

● Typically used with deflated cuff● High profile● Risk of cardiopulmonary complications if

used inappropriately

Limitations

● The LPV does not have a standard 15mm hub connector and therefore will not attach to a manual resuscitator or a ventilator circuit

● A Standard or Subglottic Suctioning Cannula of correct size should be readily available in case the use of a 15mm connector is needed

The Blom Trach Candidate● Arousable with the potential to communicate● May be in volume or pressure ventilation in any

ventilatory mode ● Does not need to be breathing spontaneously ● Does not need to be able to tolerate cuff deflation ● The patient should not have copious, thick secretions

requiring suctioning more than five times per hour ● The patient should have a patent, unobstructed upper

airway ● FiO₂should not exceed 60% & PEEP should not exceed

10

Blom Series: Sizes & Components● 2 Series of Blom Tubes

○ Rigid type material (like Shiley)○ Soft type material (like Portex)

● Standard Cannula● Subglottic Suctioning Cannula● Speech Cannula● LPV● EVR● Decannulation Plug● SoftTouch Tube Holder

Sizes ID (mm)

OD (mm)

Length (mm)

4 5.0 9.4 62

6 6.4 10.8 74

8 7.6 12.2 79

10 8.9 13.8 79

Closing ThoughtsThe Blom is not a specialty or custom tracheostomy tube and can be used as the initial tracheostomy tube. However, at this time the patient is most likely to be admitted to a hospital with a different tracheostomy tube such as a Shiley, Portex or Bivona. These are more common tracheostomy tubes at this time. Therefore, the entire tracheostomy tube must be changed to the Blom Tracheostomy Tube, to use the Blom Valve Speech Cannula or the Low Profile Valve. This is may be more difficult to do, and more costly than the Passy-Muir Speaking Valve. The PMV can fit onto the hub of all Shiley, Portex, Jackson metal, and Bivona (unable to use with foam filled Bivona). It seems that the PMV should be trialed first if the patient was admitted with a tracheostomy tube other than the Blom, if the cuff is able to be deflated.

However, the Blom Tracheostomy Tube system is another device that can be utilized in acute or long term care to help improve our patient’s communication. Patients on mechanical ventilation who are unable to tolerate cuff deflation are ideal candidates for the Blom Tracheostomy Tube to allow for speech. This may include patients with ALS, cervical spine injury, and progressive neurological disorders. The Blom Tracheostomy Tube system has shown to be safe and effective and well tolerated in individuals with mechanical ventilation (Kunduk, M. et. al, 2010).

References:

Kunduk, M., Appel, K. Tunc, M., Alanoglu, Z., Alkis, N.Dursun, G., & Ozgursoy, O.B. Preliminary report of laryngeal phonation during mechanical ventilation via a new cuffed tracheostomy tube. Respiratory Care. 55(12) 1661-90.

Questions?