Hi everyone! I am confused and need help on a topic that I read in book.
A pt with a cuffed tracheostomy. Before eating, should the RN INFLATE the cuff or DEFLATE the cuff? My med-surg book says to "Deflate" while eating, but other NCLEX books
says to "Inflate" while eating to prevent aspiration.
I think "Inflate" would make sense to prevent aspiration while eating. What does everyone think? Or what did you see in the hospitals? Could you please share your experiences and opinions on this?
Sep 20, '11
tricky answer. My new Saunders NCLEX-RN examination test bank (2011) says inflate. However, upon further research, books go either way, with the older books saying inflate the cuff before eating. Inflated may be more of a "arm-chair common sense" (i.e. not evidence-based) supposition than being based on actual research. I found a few articles concerning "inflated versus deflated cuffs" where the authors reported: food contents eventually leaked around the cuffed trach; concerns regarding trapped food particles causing an infection; and inflated cuffs made swallowing harder, thus leading to more instances of aspiration while eating. Here's an evidenced-based article that reports the aspiration rate is 2.7 times higher (P = 0.032) when cuff is inflated versus deflated. If indeed this particular evidence-based article has it right, it will take some time to get the "deflated cuff" work into the test banks, so for now, I'd answer "incorrectly", namely inflate the cuff. It's not like you can argue with the NCLEX answers at this time. So play the game, and get the point.
Daniel G. Davis
et al Swallowing With a Tracheostomy Tube in Place: Does Cuff Inflation Matter? doi: 10.1177/088506660201700304 J Intensive Care Med May 2002 vol. 17 no. 3 132-135
Patients undergoing tracheostomy may recover enough to be weaned from mechanical ventilation but continue to need the tracheostomy tube for airway toilet. When feeding a patient with a tracheostomy tube in place, it is unclear if the cuff should be inflated or not. This study was undertaken to determine whether cuff status has any impact on aspiration of feedings. Selected patients with tracheostomies who were weaned from the ventilator underwent fluoroscopic swallowing studies with the tracheostomy cuff inflated and deflated. Patients were fluoroscopically observed swallowing contrast-enhanced thin liquids, thick liquids, pureed food, and solid food. Each patient was to have undergone a total of 8 different swallowing studies. A radiologist blinded to cuff status was present to assess the degree of aspiration, which was graded from 0 (no aspiration) to 4 (aspiration of more than 10% of the ingested material with coughing). The study included 12 patients who had a total of 91 different swallowing studies. The full battery of eight swallowing studies could not be completed on every patient. When the cuff was inflated, the aspiration rate was 2.7 times higher (17.8% versus 6.5%). Logistic regression analysis revealed that cuff status and type of substance ingested were both predictors of aspiration ( P = 0.032 and P = 0.025, respectively). Although the sample size was small, the nearly threefold increase in the aspiration rate associated with cuff inflation suggests feeding with the cuff deflated may be the preferred method. Solid foods are the safest. Swallowing studies may be the best method of assessing which substances will be tolerated by an individual patient.
Last edit by ridgeway on Sep 20, '11
: Reason: better English