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Inner Cannula The purpose of the inner cannula is to reduce the risk of potential obstruction with sputum and reduce the risk of infection. Some inner cannulas are disposable, others must be cleaned and re-inserted. Different brands of tracheostomy tubes have different inner cannula connections. Cleaning aims to remove secretions from the inner cannula to reduce the risk of potential obstruction with sputum and reduce the risk of infection. Secretions can adhere to the internal lumen diameter over time, potentially increasing the work of breathing and/or obstruct the patient's airway. The inner cannula should be cleaned, or disposable cannulas replaced every eight hours and prn if any signs of respiratory distress or build-up of secretions. Each patient's requirements need to be assessed individually. A spare inner cannula should be kept in a clean container at the patient bedside when not in use. If the inner cannula becomes blocked, it should be removed immediately to clean, to prevent respiratory distress. One of the disadvantages of an inner cannula is that the small inner diameter may increase the work of breathing. If an un-cuffed tube becomes blocked, it is more likely that a patient can breathe past the tube via their upper airway, making these tubes inherently safer for non-specialist locations. Adjustable Flange Tracheostomy Tubes These tubes are used in patients who have an abnormally large distance from their skin to their trachea, and a standard tube would not fit properly. Indications for an adjustable flanged tube are patients with a very large neck girth, actual or anticipated oedema. As the flange is adjustable it is essential to review the position of the flange daily at handover and every 6 hours during the shift to ensure the tube has not rotated and continues to fit well with increases or decreases in oedema.