Tight to Shaft (TTS) tracheostomy tube

TTS tracheostomy tubes have cuffs that contract and lay flat against the shaft of the tube when not inflated. These are low volume, high pressure cuffs that should not be inflated for prolonged periods of time due to risk of injury of the tracheal mucosa. The cuff of the Bivona TTS tube must be filled with water rather than air, as air leaks out over time. A minimal occlusive volume technique should be used to determine cuff fill amount.