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This page describes products and general use; it is not medical advice.
An HME filter for a tracheostomy is a small, single-use device that clips onto the end of a tracheostomy tube and returns some of the warmth and moisture of each exhaled breath to the next inhaled breath. This page explains the variants (plain HME, HME with a microbiological filter, models with oxygen or suction ports) and the labeling and handling rules that a manufacturer’s instructions for use and hospital patient handouts share.
What a tracheostomy HME is
A heat and moisture exchanger (HME) is, in the wording of one manufacturer’s instructions for use, a “single-use heat and moisture exchanger which transfers heat and humidity from the gas expired by the patient to the inspired gases”, intended for patients breathing spontaneously through a tracheostomy tube (Avanos BALLARD 1000 Trach HME IFU). SickKids’ AboutKidsHealth describes it as a filter-like sponge attached to the end of the tracheostomy tube and lists other names: thermal humidifying filter, tracheostomy filter and “artificial nose”.
Who uses it: people with a tracheostomy who breathe on their own, and the nurses, respiratory therapists and caregivers who supply and change the device. A tracheostomy bypasses the nose and mouth, which normally warm and moisten inhaled air; UC Davis Health describes an HME as one way to provide humidification to adult tracheostomy patients, and notes that a moist airway helps thin secretions so they can be coughed out. For the tube itself, see what a tracheostomy tube is.
How it works
The device traps heat and moisture from the breath going out and releases it into the next breath coming in (SickKids AboutKidsHealth). The sources also say the device must stay dry. SickKids notes that water on the HME adds resistance, and UC Davis says the filters are not to be cleaned or have water or saline added.
HME, HME filter (HMEF) and other humidification
SickKids notes that some HMEs are combined with a microbiological filter and are then called HME filters (HMEF). Other differences described in the sources are ports and the alternatives used when an HME is not suitable.
| Variant | Key difference as described by the source | Source |
|---|---|---|
| HME (plain) | Filter-like sponge that retains heat and moisture from exhaled breath | SickKids; Avanos IFU |
| HME filter (HMEF) | An HME combined with a microbiological filter | SickKids |
| HME with oxygen port | “Not all HMEs have oxygen ports”; models with the special port are sold separately from those without | UC Davis Health |
| HME with suction port door | Some models have a suction port door | UC Davis Health |
| Tracheostomy mask or heated high-flow humidifier | Active humidification equipment named by SickKids as alternatives to an HME; UC Davis notes other humidification methods are needed whenever the HME is not in place | SickKids; UC Davis Health |
The manufacturer’s instructions rule out combining an HME with some other humidification: the Avanos IFU says “Not for use with nebulizers or vaporizing humidifiers”, and UC Davis says a mist setup is not to be placed over an HME.
Where the manufacturer and hospital guidance agree
The same four rules appear in a manufacturer’s instructions for use and in hospital patient education. The table puts them side by side. One product’s instructions are not class-wide specifications, so always follow the instructions packed with the specific device.
| Topic | Avanos BALLARD 1000 Trach HME IFU | UC Davis Health patient instructions | SickKids AboutKidsHealth |
|---|---|---|---|
| Change interval | Every 24 hours, or sooner if necessary | At least every 24 hours, or more often if clogged | Every day if used throughout the day; as soon as possible if excessively moist, soiled or plugged with mucus |
| Reuse | Single-patient use; do not clean and reuse | Do not reuse; one-time use | – |
| Nebulizers and mist | Not for use with nebulizers or vaporizing humidifiers | Mist setup not to be placed over an HME | – |
| Water | – | Do not clean the filters or add water or saline | Do not let water contact the HME; it adds resistance |
Handling and labeling basics
- Airflow. The Avanos IFU says to verify before use that the device has no occlusions and that air will flow through it.
- Ports. Oxygen ports and suction port doors are features of some models only (UC Davis Health). Check the product label for which ports a model has.
- Internal filters. UC Davis says that if the internal filters move, the device is to be discarded rather than repaired.
- Connector. The Avanos IFU lists a 15 mm female patient connector (ISO standard) for that product; check the connector on any model against the tube it is paired with.
Related equipment pages: tracheostomy collar (an alternative humidification set-up), Passy-Muir valve and respiratory therapy equipment.
Labeled limits of an HME
- Secretions. The Avanos IFU lists fulminating frothy secretions as a contraindication. UC Davis notes that heavier or thicker secretions can clog an HME.
- Very small tidal volumes. The Avanos IFU states that its device is not for patients with very small tidal volumes, for example neonates or very small children.
- Prescription labeling. The Avanos IFU labels its device as prescription only (Rx only).
Common mistakes
- Adding water or saline to the HME, or placing a mist set-up over it (UC Davis; Avanos IFU).
- Rinsing or reusing a device that is labeled for single use (Avanos IFU; UC Davis).
- Assuming every model has an oxygen port (UC Davis).
Frequently asked questions
What is an HME filter for a tracheostomy?
It is a single-use device on the end of a tracheostomy tube that transfers heat and moisture from exhaled breath to the next inhaled breath (Avanos IFU). Versions combined with a microbiological filter are called HME filters (HMEF), per SickKids.
How often is it changed?
The Avanos instructions and UC Davis Health both give 24 hours as the labeled change interval, with sooner replacement if the device is clogged. Follow the instructions packed with the specific product and the care team.
Can it be washed and reused?
No. The Avanos IFU says it should not be cleaned and reused, and UC Davis says the HMEs are for one-time use.
Can an HME be used with oxygen or a nebulizer?
Only some models have an oxygen port (UC Davis). The Avanos IFU says its HME is not for use with nebulizers or vaporizing humidifiers.
Sources
- Avanos Medical, BALLARD 1000 Trach HME instructions for use (https://connect.myairlife.com/resources/BALLARD%20HME%201190_IFU_15M122901_00.pdf), checked 2026-10-30.
- UC Davis Health, Otolaryngology, https://health.ucdavis.edu/otolaryngology/specialty/Trach-HME-patient-education.pdf (HME (Heat Moisture Exchanger) for Tracheostomies, Patient Instructions for Home Use), revised 06/2018, checked 2026-10-30.
- The Hospital for Sick Children, AboutKidsHealth, https://www.aboutkidshealth.ca/heat-and-moisture-exchangers (Heat and moisture exchangers), checked 2026-10-30.
