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Uncuffed Tubes Uncuffed tubes do not have a cuff that can be inflated inside the trachea and tend to be used in longer-term patients. An uncuffed tube maintains airway patency but also enables voice production (air can flow around the tracheostomy tube and through the vocal cords). Fenestrated Tubes Fenestrated tubes have an opening(s) on the outer cannula, which allows air to pass through the patients oral/nasal pharynx as well as the tracheal opening. The air movement allows the patient to speak and produces a more effective cough. However, the fenestrations increase the risk of oral or gastric contents entering the lungs. A non-fenestrated inner cannula should be used for patients at high risk of aspiration. Suctioning with a fenestrated tube should only be performed with the non- fenestrated inner cannula is insitu, to ensure correct guidance of the suction catheter into the trachea.