The TIDI Posey Secure Trach Ties (12 per Pack) are designed for use with Tracheostomy tubes, and help to secure them in place during medical treatment. Two extra ties are attached to a hook and loop trach tie, to maximize connection with the elbow or swivel adapter without the need for rubber bands. Features TIDI Posey Secure Trach Ties Features Helps prevent extubation for Tracheostomy tubes. Hook and loop tie, with an additional two ties for security (15.5" / 39 cm). Sizes TIDI Posey Secure Trach Ties Sizes MPN Size Dimensions Fit #8196S Small 9" (L) x 1" (W) (23 cm x 3 cm) Infant necks - 7 to 9" (18 to 23 cm) #8196M Medium 18" (L) x 1" (W) (47 cm x 3 cm) Adolescent and adult necks - 9 to 14" (23 to 35 cm) #8196L Large 23" (L) x 1" (W) (60 cm x 3 cm) Adult necks - 13 to 19" (33 to 48 cm) Literature TIDI Posey Secure Trach Ties Literature TIDI Posey Secure Trach Ties Application Instructions