Friday, 5 June 2015

HME's - Swedish Nose v Bib - A Patient's view

When you have a tracheostomy you intake all your air through a tube inserted into your throat. One of the problems with this is that the air goes in dry and cold and doesn't have the benefit of the warming and filtering effects of you nose. In order to replace your nose's function a HME (heat and moisture exchange) is required.
Up until a week ago I have always used a Buchanan bib but at my last hospital visit it was suggested I should try a Swedish nose.
After my first week here is what I see as the pros and cons of the two systems.

Buchanan bib

  • The bib covers the trachi and gives the patient some privacy when out in public. A stranger would not know what was under the bid and not necessarily know the patient had an illness or disability.
  • The bib can be washed and is easy to keep clean.
  • A bib lasts three days.
  • The bib catches projectile spit/mucus that can be ejected from the trachi when coughing.


  • Unfiltered air can still enter the trachi around the sides and the bottom of the bib.
  • Although in hides the trachi the bib is fairly obvious and doesn't match most outfits so can look out of place.
  • In high winds the bib can be sucked against the trachi and cause some breathing problems.

Swedish nose

  • The Swedish nose fits snug on the end of the Trachi and therefore all the air is filtered.
  • There is a flanged opening so suction can still be carried out even with the HME in place.
  • I have found if you wear the Swedish nose under your shower protector in stops the shower protector from occluding the trachi and makes breathing much easier.
  • It stops mucus from escaping when you cough and staining or being absorbed into your clothes. 


  • The Swedish nose attaches onto the end of the trachi and therefore the whole of the trachi is visible when you go out.
  • It only lasts 24 hours and then you need a new one.
  • If you cough and produce a lot of mucus and don't suction as you cough, it can gather in the Swedish nose. This causes moisture build up which means the HME loses efficiency. This can also make breathing feel more laboured which means changing the HME more regularly.
  • If you have a strong cough, as I do, you can cough the HME off. So make sure you always carry a spare.
  • More pressure is needed to occlude the trachi to talk. If you have a sensitive trachi this can lead to more coughing.

I have had a few teething problems getting used to the Swedish Nose but if it is protecting my airways and giving me less chance of getting a chest infection then that can only be a good thing.

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