Some tracheostomy tubes have a subglottic port. These are used to help reduce the secretions that build up above the cuff (Fig 1). When used as part of a bundle of care, these tubes can help reduce the incidence of ventilator-associated pneumonia. These tubes are recommended as the first tube that is inserted for a ventilator-dependent ICU patient.

The subglottic port should be aspirated every few hours; more frequently if necessary (Fig 2). Document the volume and nature of secretions, as this can be useful in assessing whether any intervention is required to help manage upper airway secretions. Sometimes the tubes get blocked. They can be flushed with air or small volumes of saline, but check the manufacturer’s instructions first, as different tubes have different recommendations.

Fig 3 is a short video demonstrating how to aspirate from the subglottic suction port.

Subglottic suction ports can also be used to deliver a low flow of gas (air or oxygen) backwards, up the subglottic suction port, to exit above the cuff. This gas flow can then travel upwards through the trachea, pass through the vocal cords and exit via the mouth. This is called Above Cuff Vocalisation (ACV). You can learn about ACV and other methods of communication in module 6 of this series.