ENDOTRACHEAL CUFF INFLATION

Endotracheal Cuff Inflation

Endotracheal Cuff Inflation

Introduction

Stabilisation of the tube (and cuff) is crucial in tracheal mucosa protection. Pressure necrosis at the site of tracheotomy stoma can be reduced by the use of swivel connectors and ventilator tubing supports that will prevent undue traction on the tracheotomy tube. The tracheal mucosa is sensitive to the motion at the tip of the tube against the tracheal wall, which can be reduced by correct positioning and securing of the tube. (Fox 2004:60-64)

Careful wound care can help prevent local infection that may lead to further destruction of the exposed tracheal stroma or cartilage. Although routine cuff deflation is not indicated, it can be used in the following selective situations: to clear the upper airway of secretions, to allow patients to vocalise, and to check for a cuff leak. (Galal 2006:270-277)

The use of positive pressure when deflating cuffs to pre-vent aspiration of upper airway secretions is a good technique that can help to prevent infection. (Galal 2006:270-277)

Research Question

What influences post course ICU nurses' methods of endotracheal cuff inflation and cuff pressure measurement in the Mechanically Ventilated patient?

Aims and Objectives

Aim

To explore the knowledge of post- course intensive care nurses towards endotracheal cuff management by the use of Qualitative Methodology.

Objectives

Examine the methods of endotracheal cuff inflation used by nurses.

Explore the frequency of assessment of endotracheal cuff pressure for sedated and ventilated patients.

Analyze the local policies and procedures that govern the practices of the ICU nurse for the management of endotracheal tubes.

Identify knowledge and resource barriers that limit appropriate practices of endotracheal tube management.



Theoretical Framework

A tracheal stenosis can be caused by a direct traumatic injury to the trachea, severe tracheitis, or by factors related to intubation, i.e. cuff pressure, non-stabilised tube and poor hygiene. Persistent high cuff pressure results in the destruction of the tracheal wall. The careful monitoring of cuff pressures, tube stability and hygiene of an endotracheal or tracheostomy (ET/TT) tube could play an important role in the prevention of tracheal stenosis. (Abbot 2008:347-352)

During the past few years an alarming number of patients have presented with acquired tracheal stenosis in the Bloemfontein area. Most patients were treated in intensive care units (ICUs) in the Free State. Therefore, the aim of this study was to establish whether ICU staff were adequately informed about the use and care of ET/TT tube cuffs. (Finholt 2007:326-329)

Airway leaks in mechanically ventilated patients will occur whenever a tracheal tube (TT)-airway geometric mismatch is present. While inability to sufficiently ventilate patients due to leaks is rare, their presence can diminish the efficacy of mechanical ventilation, decrease lung recruitment with positive pressure support undermine the clinical value of lung mechanics measurements for weaning and assessment of the disease process.

Adults requiring mechanical ventilation are routinely intubated using uncuffed tracheal tubes. Consequently, airway leaks around the TT are common in these patients, and may frequently affect their clinical management. These leaks are tolerated out of concern that use of a tight-fitting TT of any kind! or cuffed TT with potentially overinflated cuffs can lead ...