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About tracheostomy and artificial noses

What is an artificial nose?

An artificial nose is a medical device used in the care of patients with a tracheostomy. It fulfils and replaces those important tasks of a natural nose, when breathing is no longer possible via nose, mouth and throat. It has the following function:

  • Warming of the air
  • Particle filtering of the air
  • Humidification of the air
  • Restoration of breathing resistance

Terms and classification

Artificial noses are so-called humidity and moisture exchangers. The following terms refer to the same thing:

  • HME (Heat and Moisture Exchanger)
  • Artificial nose

Artificial noses belong to the class of medical devices of breathing air conditioners. Here, a distinction is made between active and passive methods. Active respiratory humidifiers actively bring heat and moisture into the air. Examples are nebulizers or inhalers, which are operated using electrical power. Artificial noses belong to the class of “passive respiratory humidifiers. These store heat and moisture from the exhaled air in order to emit these back into the inhaled air. These functions are carried out by the filter medium; see also “How does an HME work?”

Where and how are artificial noses attached?

In tracheotomised, spontaneously ventilated patients, the artificial nose is attached to the connector at the tracheal cannula. In spontaneously ventilated patient, they represent the only effective means of taking over the functions of humidifying, heating and filtering the air, and to restore the breathing resistance.

HME auf Trachealkanüle

During artificial respiration, an HME as a passive humidifier is an effective and inexpensive alternative to active humidifying systems. In ventilated patients, the HME is positioned between the tube extension and the Y-fitting.

Why is it sometimes difficult to replace an artificial nose?

HME have to be firmly and securely attached to the tracheal cannula. Thus, they are inevitably difficult to attach and remove. With a conventional HME, the 15 mm connector that secures the connection to the tracheal cannula is inflexible and rigid. And the 15 mm norm connectors on the cannula are also rigid and, in addition, differ in terms of the surface properties. This makes it difficult to attach and remove the HME in a patient-friendly way. Every rotation and application of force to the cannula can be associated with unpleasant sensations, irritations and strain.

Kanülentrenner Beispiel

The separating wedge is an aid for improved removal of artificial noses from the tracheal cannula. The existence of such a device alone indicates the problem. The sanabelle solution is called CLIP TO FIT. With this clip function, HME can be attached and removed smoothly and without applying force. Read more about the CLIP TO FIT system or watch our film on the homepage.

What is a tracheostoma?

A tracheostoma is an artificial opening of the windpipe following by a tracheotomy, a tracheostomy or a laryngectomy.

Trachealkanüle Tracheostoma

"Tracheotomy" describes the placement of an incision in the windpipe without suturing the structure of the trachea. By means of the technology of percutaneous dilatation tracheotomy, an instable granulation canal is created in order to insert a tracheal cannula. The term “tracheostomy” is used for a surgical placement of a stable canal by suturing the exterior neck skin in the tracheotomy opening. A tracheostomy is frequently used when, e.g. the upper airways have been repositioned due to fractures in the midface, malformations, burns or tumours (including the oesophagus), or when the breathing muscles are impaired, for example in the case of paralysis or neurological diseases.

The term “laryngectomy” is used when the entire larynx has been removed. This means the complete and irreversible separation of the upper and lower airways, making reconstruction impossible.

Why are artificial noses so important?

Without the use of an HME, air would be too cold and too dry to breathe, and breathing resistance would be too low. Even after only a few minutes of not using an artificial nose (e.g. immediately after surgery), the tracheal mucus membrane dries out and ossification occurs, drastically increasing the risk of infection. In addition, the HME is an efficient filter of foreign matter, such as dirt, dust particles and insects. An HME also partially recreates the lost resistance when exhaling. It keeps the alveoli open in order to improve the supply of oxygen to the blood. Thus, an HME helps to keep the pressure levels in the lungs similar to those before surgery.

How does an HME work?

Artificial noses are generally made of a plastic shell and a material that can assume the function of a natural nose, the so-called filter medium. This could be either paper or foam. The filter medium (also known as moisturizing medium) is covered in a layer of hygroscopic salt, which binds the moisture in the exhaled air and releases it again when inhaling.

What are the important features of an HME?

When selecting a suitable HME, attention should be paid to specific features. The most important is the so-called tidal volume. This describes the volume breathed in and out during each breath. The tidal volume depends on the patient’s weight, and corresponds roughly to 7-8 ml per kg of ideal body weight. Furthermore, the artificial nose should have a moisture storage capacity that is optimal for the patient (moisturizing level). If the patient requires additional oxygen, the HME should have an oxygen port. It is also important to ensure that the HME does not become blocked when large amounts of secretion are coughed up, and that it has proper safety mechanisms.