Written and maintained by CASRAI Editorial Board
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This page describes products and general use; it is not medical advice.
A tracheostomy collar (also called a trach collar or mist collar) is a light, open interface that sits over a tracheostomy opening so humidified air or a nebulized medicine can reach the airway. The same search also returns two different products: the ties or holder strap that secure a tracheostomy tube, and the rigid cervical collar used for neck support. This page separates the three so you can tell which one a request, supply list or product listing means.
Who uses it: people with a tracheostomy and the clinicians, caregivers and supply buyers who support them. Pediatric patient-education material from a children’s hospital describes the mist collar as part of everyday humidification.
What a tracheostomy collar is
A tracheostomy collar delivers humidity or aerosol to the front of a tracheostomy. The University of Rochester Medical Center Children’s Hospital explains why humidity matters: it helps keep mucus loose, prevents plugging, and prevents the coughing that dry air can cause. It lists the mist collar (trach collar) as one of the ways to supply that humidity, alongside a heat and moisture exchanger (HME, sometimes called an artificial nose). The airway itself is described on what a tracheostomy tube is.
Trach collar vs trach ties vs cervical collar
| Product | What it does | Source |
|---|---|---|
| Trach (mist) collar | Aerosol and humidity interface over the tracheostomy; a nebulizer attaches to the elbow of the collar | URMC Children’s Hospital; Respir Care 2015 |
| HME (artificial nose) | Alternative humidity device that sits on the tube itself; described as used when off the mist collar while a child is awake | URMC Children’s Hospital |
| Trach ties / holder strap | Secures the tracheostomy tube; US product code CBH, “Device, Fixation, Tracheal Tube” | NLM AccessGUDID |
| Rigid cervical collar | Neck support brace; a different product with a separate guide: cervical collar types and sizing | CASRAI guide |
What is a tracheostomy collar used for?
It is used to supply moisture or aerosol to a tracheostomy. According to URMC’s pediatric guidance, the mist collar is recommended at nighttime and nap time for infants and smaller children, and for all children if secretions are thick or during respiratory illness. The same page notes that an adequate amount of water is needed to supply a sufficient mist. A nebulizer is attached to the elbow of the trach collar; URMC states a nebulizer treatment should always be given with a trach mask or collar and never attached directly to the tracheostomy. That guidance is written for children and their families; it is not a recommendation for any individual.
What are the different types of tracheostomy collars?
The collar product is the mist (aerosol) collar, with an HME as the alternative humidification device and ties or holder straps as the securing product. Fenestration status of the tube (open or closed) is a property of the tube, not the collar.
Trach ties and holder straps
Ties are a distinct product. In NLM’s AccessGUDID, one manufacturer’s adult one-piece trach tie record reads “Adult One Piece Trach Ties, 2.5x43cm (17in) – 20/box”, with product code CBH, not packaged sterile, single-use, and “Device Exempt from Premarket Submission: Yes”. This is one manufacturer’s listing, not a standard for all ties. The CASRAI guide on tracheostomy tubes notes that the tube flange is secured with ties or a holder.
How to choose the right size tracheostomy collar
Collars do not have a single published size chart. Tie dimensions are set by each manufacturer (the AccessGUDID example above lists 2.5 cm by 43 cm), and the tracheostomy tube itself is sized and chosen clinically. Selection criteria that are documented concern use rather than size: URMC’s pediatric page distinguishes the mist collar (nighttime, naps, thick secretions, respiratory illness) from the HME (when the child is awake and off the collar).
What the aerosol evidence shows
A 2015 bench study in Respiratory Care (Bugis AA, Sheard MM, Fink JB, Harwood RJ, Ari A; PubMed 25922541) compared aerosol delivery by a tracheostomy collar, a Wright mask and an aerosol mask. It used an in vitro adult tracheostomy mannequin model, not patients, with albuterol from a jet nebulizer. The collar delivered 9.4 ± 1.5% of the dose to the bronchi with the fenestration closed and 7.0 ± 0.8% with it open, and both masks delivered less than the collar under either condition. An inspiratory-to-expiratory ratio of 2:1 caused greater deposition than 1:2. The authors concluded that closing the fenestration improved aerosol delivery. Results from a mannequin do not predict what any individual patient receives.
Safe use and handling basics
- Follow the product’s instructions for use and the care team’s instructions.
- Per URMC, an HME is replaced at least daily and when full of secretions, is for 24 hours of use only, and should be removed if the child is agitated because it may be plugged.
- Never attach a nebulizer directly to the tracheostomy (URMC); it goes on the collar elbow.
Common mistakes
- Treating “trach collar”, “trach ties” and “cervical collar” as one product when ordering or reading a supply list. See the long-term acute care hospital supply checklist for how such supplies are grouped.
- Giving a nebulized medicine through the tracheostomy directly instead of through the collar (URMC).
- Letting the water supply run low, since an adequate amount of water is needed for sufficient mist (URMC).
- Assuming the 9.4% and 7.0% bench figures describe what a patient receives; they come from a mannequin.
FAQ
What is a tracheostomy collar used for?
To deliver humidity or aerosol to a tracheostomy. URMC’s pediatric page describes it as recommended at night and nap time for infants and smaller children, and when secretions are thick or during respiratory illness.
What are the different types of tracheostomy collars?
The collar product is the mist (aerosol) collar. Related products are the HME, which sits on the tube, and trach ties, which secure the tube. The rigid cervical collar is an unrelated neck brace.
How do I choose the right size?
Tie dimensions vary by manufacturer and the tube size is set clinically, so the manufacturer’s instructions for use and the care team are the references.
Related guides
See also ventilator-associated events for how airway-related complications are tracked in hospitals.
Sources
- Bugis AA, Sheard MM, Fink JB, Harwood RJ, Ari A. Comparison of Aerosol Delivery by Face Mask and Tracheostomy Collar. Respir Care 2015;60(9):1220-6. PubMed 25922541, checked 2026-10-30.
- University of Rochester Medical Center Children’s Hospital, Tracheostomy humidification (pediatric patient education), checked 2026-10-30.
- NLM AccessGUDID, Adult One Piece Tracheostomy Tie record, checked 2026-10-30.
