Development of the novel Tracoe Twist Plus tracheostomy tube

Introduction

The 4th National Audit project, conducted by the Royal College of Anaesthetists in 2011, reviewed major airway complications in the UK [1]. It highlighted tracheostomy tube displacement as a significant risk in critical care patients. Prior to 2011, at the Royal London Hospital ICU, the Tracoe Twist (marketed by Kapitex) was primarily used as the default choice of tracheostomy tube. However, over a 5-year period, there were a significant number of critical incidents related to tracheostomy tube displacement or blockage. On investigation of these incidents, root-cause analysis identified inadequate length of the Tracoe Twist as a major contributing factor. As a consequence of this, there was also an increasing requirement for the use of adjustable flange tubes. This was particularly apparent in obese patients. Our objective was to develop a new tracheostomy tube that would reduce the number of incidents related to inadequate length. An additional aim was to maximise the inner diameter for a given external diameter, thus reducing airway resistance and potentially aiding weaning.

Methods

We formed a consultation committee, consisting of consultants in critical care, a consultant surgeon and a consultant anaesthetist with a specialist interest in head and neck anaesthesia and tracheostomy care. We collaborated with the Kapitex design team to develop a new tracheostomy tube which addressed some of the perceived deficits of existing devices.

Results

We developed a prototype tracheostomy tube that had an increased length for a given internal diameter. We also increased the mobility to flange, in order to reduce pressure areas and assist with fixation. A third modification was to ensure a maximal internal diameter for a given external diameter. We piloted its use in 20 patients. No adverse events were observed and the clinical impression was that the increased length was beneficial to the patients.

Conclusion

Following the success of the pilot study, this new tracheostomy tube was developed and then marketed by Kapitex. This tube was named the Tracoe Twist Plus. We have now used this tube for 2 years. We have since performed an extensive retrospective audit of tracheostomy usage and the effect of the introduction of the novel Tracoe Twist Plus, and the complication rate was reduced in terms of displacement and obstruction.