FIGURE 135.2 Dual cannula tracheostomy tube Swivel A swivel is often attached to the end of the tracheostomy tube Some unique characteristics of children make the swivel particularly useful First, children have a natural inclination to move and explore The swivel device accommodates movement in the ventilator-assisted child, so traction is not placed on the ventilator tubing or on the tracheostomy tube Second, the short neck and bulky soft tissues of young children can obstruct the tracheostomy tube opening The swivel provides additional length, so the tube opening extends beyond the soft tissues of the neck Heat–Moisture Exchanger Air inspired directly into the trachea through a tracheostomy tube bypasses the important warming and humidification mechanisms provided by the natural upper airway Therefore, a humidification system is an important component of the equipment used in a patient with a tracheostomy A home ventilator setup