Tracheal Tube Cuff Care

.  Wash hands and don personal protective equipment.
2.  Remove oxygen tubing attached to the endotracheal or tracheostomy tube.
3.  Hyperoxygenate and suction tracheobronchial tree and pharynx before cuff deflation.
4.  Minimal Occlusion Volume (MOV) Technique
5.  Deflate cuff while applying positive pressure.
6.  Insert air-filled, 10-ml syringe tip into inflating tube valve.
7.  Slowly inject air on inhalation until sounds cease over larynx.
8.  Apply positive pressure with manual resuscitation bag.
Proceed to step 11.
  Minimal Leak Technique (MLT)
9. Place a stethoscope over larynx.
10. Slowly withdraw air (in 0.1-ml increments) from the cuff until a small leak is heard by auscultation on inspiration.
11. Remove syringe tip.
12. Replace any oxygen or humidity tubing. Check and secure ventilator connections, as needed.
13. Reassess patient's airway and respiratory status.
Cuff Pressure Measurement
14. Wash hands and don personal protective equipment.
15. Connect the manometer line to the patient inflation system with a three-way stopcock (turned "off" to the patient).
16. With your thumb, occlude the open port, and, with an air-filled syringe, inject air into the tubing leading to the manometer until the needle of the manometer reads between 20 and 25 mm Hg.
17. Turn the stopcock off to the open port (syringe). Read the cuff pressure now shown on the aneroid face.
18. Turn the stopcock off to the inflating tube. Disconnect the manometer line from the patient's inflation line.
19. Detach the manometer line with three-way stopcock from the patient's inflation system.
Troubleshooting Tracheal Cuff Problems
Faulty Inflating Valve
20. Identify faulty inflating valve.
Cuff Pressure Measurement
21. Insert three-way stopcock into the distal opening of the inflating balloon.
22. Inflate the cuff using mimimal occlusion volume (MOV) technique (steps 6-8, 11) or minimal leak technique (MLT) (steps 9-11).
23. Clamp the inflating tube by applying a padded hemostat distal to the pilot balloon.
24. Turn the stopcock off to the inflating tube; remove clamp.
Faulty Inflating Line
25. Identify malfunctioning of inflating line.
26. Cut off faulty end of inflation line with scissors.
27. Insert short 18- to 23-gauge blunt needle into inflation line.
28.Attach a three-way stopcock to a blunt needle.
29. Using a 10-ml syringe, inflate the cuff with air using MOV technique (steps 6-8, 11) or MLT (steps 9-11).
30. Turn the stopcock off to the inflating tube.
31. Secure assembled device with tape to a tongue depressor.
32. Document in patient's record.