A Shiley is a brand of tracheostomy tube, one of the most widely used in hospitals and home care settings. It’s a curved plastic tube placed through a small surgical opening in the front of the neck (called a stoma) to create a direct airway into the windpipe. People need a Shiley when they can’t breathe adequately through their nose and mouth, whether due to a prolonged need for a ventilator, an obstruction in the upper airway, or conditions that weaken the muscles involved in breathing.
How a Shiley Tube Works
The tube sits in the windpipe and bypasses the mouth, nose, and throat entirely. Air flows directly in and out through the tube, and a ventilator or other breathing equipment can connect to it via a standard 15mm connector on the outer end. A neck plate (also called a flange) rests flat against the skin of the neck, and a strap loops around the back of the neck to hold everything in place.
Most Shiley tubes use a dual-cannula design, meaning there’s an outer cannula that stays in the windpipe and a removable inner cannula that slides inside it. The inner cannula is the part that collects mucus and secretions over time. Because you can pull it out for cleaning or replacement without disturbing the outer tube, it makes daily maintenance much simpler and reduces the risk of the airway becoming blocked.
Types of Shiley Tubes
Shiley tubes come in several configurations, each suited to different situations:
- Cuffed: These have an inflatable balloon near the tip that seals the space between the tube and the windpipe wall. The seal prevents air from leaking around the tube, which is essential for patients on a ventilator. The cuff material is designed to soften at body temperature to protect the delicate tissue lining the windpipe.
- Cuffless: These lack the inflatable balloon and are designed for people who breathe on their own. They’re lighter, more comfortable for long-term use, and allow some air to pass around the tube and up through the vocal cords.
- Fenestrated: These have one or more small holes in the curved portion of the outer cannula. The openings allow air to flow upward through the vocal cords, making speech possible. Fenestrated tubes are commonly used when a patient is being weaned off the tracheostomy, serving as a transitional step. They can also reduce the effort of breathing and decrease how often suctioning is needed.
- Extended-length (XLT): These are longer tubes designed for patients with thicker necks or unusual airway anatomy where a standard-length tube wouldn’t reach far enough into the windpipe.
Common Sizes
Shiley tubes are numbered by size, and the right fit depends on the patient’s anatomy. For adult flexible tracheostomy tubes, the most common sizes range from 4 to 10. A size 4 has an inner diameter of 6.5 mm and a length of 62 mm, while a size 10 has an inner diameter of 10.0 mm and a length of 79 mm. Sizes 6 and 8 fall in between, with inner diameters of 7.5 mm and 8.5 mm respectively. A tube that’s too large can irritate or damage the windpipe; one that’s too small won’t provide a proper seal or enough airflow.
Speaking With a Shiley
One of the biggest concerns for patients and families is whether someone with a tracheostomy tube can talk. With a standard cuffed tube fully inflated, speech is difficult or impossible because air can’t reach the vocal cords. But there are workarounds. Deflating the cuff allows some air to pass upward. Fenestrated tubes make this easier by providing an additional pathway for airflow through the tube wall itself. A one-way speaking valve can also be attached to the outer opening of the tube, directing exhaled air up past the vocal cords while still allowing inhalation through the tube.
Daily Care and Maintenance
Keeping the tube clean is critical to preventing blockages. Mucus naturally accumulates inside the inner cannula, and if it dries and hardens, it can partially or completely obstruct the airway. For reusable inner cannulas, cleaning involves soaking the cannula in sterile saline or a solution of half hydrogen peroxide and half water, then gently scrubbing with a small brush or pipe cleaner to remove mucus. A thorough rinse afterward removes any cleaning solution residue.
Disposable inner cannulas skip this process entirely. They’re designed for single use: you remove the old one, discard it, and snap in a fresh one on whatever schedule your care team recommends. This is often the preferred option at home because it’s faster and reduces infection risk.
All Shiley tracheostomy tubes are designed for single-patient use and should be replaced within 29 days. Your care team will set the exact replacement schedule based on the tube type and how quickly secretions build up.
Potential Complications
Tracheostomy tubes are generally safe, but they do carry specific risks that patients and caregivers should recognize:
- Mucus plugs: Dried mucus can block the tube or the windpipe itself. Adequate hydration, regular suctioning, and using humidified air all help prevent this. A few drops of sterile saline instilled into the tube before suctioning can loosen stubborn secretions.
- Accidental decannulation: The tube can come out unexpectedly, especially during sleep or activity. If this happens, the stoma can begin to close quickly. Having a replacement tube (including one size smaller as a backup) within reach is standard safety practice.
- Bleeding: Minor bleeding around the stoma site is common, particularly after suctioning. Suctioning too deeply is a frequent cause, as the catheter can injure the lining of the windpipe.
- Granulation tissue: The body sometimes reacts to the tube by growing sensitive, easily irritated tissue around the stoma opening or inside the windpipe. This tissue bleeds easily when disturbed and may need treatment if it becomes excessive.
Why You Might Hear This Term
Shiley has become something of a generic name in hospitals, similar to how people say “Band-Aid” instead of “adhesive bandage.” Nurses and respiratory therapists often refer to any tracheostomy tube as “a Shiley,” even when they mean the device category rather than the specific brand. The tubes are manufactured by Medtronic (previously Covidien) and have been a standard in airway management for decades. If someone tells you a patient “has a Shiley,” they mean the person has a tracheostomy tube in place and is breathing through an opening in their neck rather than through their mouth and nose.