Measuring Endotracheal / Tracheostomy Tube Cuff Pressure

LIMITATIONS FOR PRACTICE: RN who has been instructed in this procedure.

AIM: To measure the cuff pressure of endotracheal / tracheostomy tubes. To ensure adequate seal without exerting unnecessary pressure on the tracheal mucosa.

EXPLANATION: Normal tracheal perfusion pressure is approximately 30mmHg (40cms H2O). Maintaining the cuff pressure below 25cms H2O helps guard against tracheal ischaemia and necrosis. It should be noted that tracheal perfusion pressure is lower in hypotensive patients. In all cases, inflate the cuff only until the leak has been occluded (minimal occlusive pressure) to avoid any unnecessary pressure on the tracheal mucosa.

EQUIPMENT: 2 x Cuff pressure manometer (kept in cardiac arrest trolley) Endotracheal / tracheostomy tube PROCEDURE: 1. Attach pressure gauge to pilot tube. 2. Measure cuff pressure. Pressure should be <25cms H2O. 3. If pressure is low and leak detected, inflate cuff only until the leak has stopped. 4. If pressure is high, ie >25cms of H2O, let cuff down to normal limits. If a leak is detected at this level, inflate the cuff to a level so that it wont leak and inform the MO. 5. Record pressure on flow chart. Tube may have a faulty cuff and patient may need to be reintubated.

The St George Hospital ICU Nursing Procedure Manual

Revised August 2003

FREQUENCY: Cuff measurement attended: at the beginning of each shift after intubation following gaseous anaesthesia if cuff leak present

TROUBLESHOOTING: PROBLEM High cuff pressure >25cms H2O. POSSIBLE CAUSES 1. High pressure, low volume cuffed endotracheal tube (ETT) insitu, eg Mallincrodt, Portex blue line. ACTION 1. Maintain cuff seal. inform MO. Patient will need reintubation with low pressure, high volume ETT if intubated for >24 hours. 2. Check for cause of high pressure. Maintain cuff seal. Inform MO. 3. Maintain cuff seal. Inform MO. Patient will need reintubation with larger ETT if to remain intubated. 1. Constant observation for cuff leak. 2. Inflate cuff if a leak detected. 1. Inflate cuff until leak occluded. maintain seal for a long as possible. 2. Inform MO. Patient will need reintubation. 3. Check length of ETT on CXR. Deflate cuff and position ETT further down the trachea.

2. High peak airway pressure.

3. ETT may be too small for particular patient.

Low cuff pressure <15cms H2O.

1. Well fitting, low pressure, high volume cuffed ETT. 2. Low peak airway pressure.

Persistent cuff leak.

1. Cuff pressure too low. 2. Damaged cuff and/or pilot tube. 3. ETT too far out and cuff sitting between the vocal cords.

The St George Hospital ICU Nursing Procedure Manual

Revised August 2003