Fenestrated Tracheostomy Tube


  • fenestrated tracheostomy tube


  • allows patient to breath normally with a tracheostomy in situ
  • patient can cough and speak through mouth
  • improves swallow function
  • acts a step prior to decannulation


  • comes with an outer cannula, inner cannula, obturator, cuff and plug
  • outer cannula = keeps stoma from closing
  • inner cannula = can be removed for cleaning
  • obturator is used when putting the outer cannula into the stoma
  • fenestrations are holes on the posterior part of the tube above the cuff
  • with the cuff up and a non-fenestrated inner cannula there is no air leak


  • need to remove inner cannula or use a fenestrated inner cannula
  • need to occlude the outer cannula opening with a plug, speaking valve or finger
  • on expiration with the cuff deflated, air passes upwards through the cords through the fenestration and around the tube enabling vocalisation
Fenestrated Tracheostomy Tube 1
Fenestrated Tracheostomy Tube 2


  • see tracheostomy insertion techniques

What if it falls out?

  • falls out and is < 5 days old -> reintubate orally
  • if falls out after 5 days -> don’t worry can re-insert



  • suctioning without an inner cannula -> tubing going though fenestration and damaging posterior wall of trachea
  • aspiration
  • requirement for a surgical procedure


  • haemorrhage
  • surgical emphysema
  • pneumothorax
  • air embolism
  • cricoid cartilage damage
  • pretracheal dilation and placement
  • endobronchial placement
  • cuff herniation
  • occlusion of tip by carina or tracheal wall
  • transfixation of trachea and placement in the esophagus
  • …death


  • infection (tracheostomy site, larynx, tracheobronchial tree, mediastinum)
  • obstruction with secretions
  • ulceration/perforation (mucosal, inominate artery, tracho-oesophageal fistula)
  • dysphagia c/o mechanical compression of oesophagus (requires N/G or PEG for enteral nutrition)
  • problems with decannulation -> emergency airway management


  • tracheal granulomata
  • tracheal or laryngeal stenosis
  • persistent sinus @ tracheostomy site
  • tracheomalacia
  • aphonia/dysphonia (recovery of voice, laryngeal or cord dysfunction)
  • tracheoesophageal fistula
  • tracheal dilatation

References and Links


Social media and web resources

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.