Cuffed Trached pt while eating..what to do?

  1. 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?

    Thank You!
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    About Miley22

    Joined: Jan '07; Posts: 90; Likes: 6
    RN; from US


  3. by   lilmith
    i think you suction and deflate the cuff. what was the rationale to the question that said to inflate the cuff?
  4. by   Miley22
    My med-surg text book says to "position the pt up right and deflate the tube cuff during meals because the cuff can ballon backwards and interefere with the passage of food through the esophagus."

    I think this also makes sense.

    If this is an nclex question....which answer would everyone else choose? Defate or inflate the cuff?
  5. by   MyLuckyDay365
    If pt has a cuffed tracheostomy tube, the cuff should be inflated a while when pt is eating to prevent aspiration.
  6. by   caliotter3
    I would hope this one doesn't show up on the test. There seems to be a difference of opinion on what to do.
  7. by   Jenni811
    Inflate if they are breathing through trach. It is there to prevent aspiration. You don't want to inflate too much that you cause tissue necrosis.

    The inflation seals off the area around it so they cannot aspirate on food, but the tube is still open so they can still breathe.

    FYI: I'd bet my life on it being inflated while eating.
  8. by   Jenni811
    Quote from thanhbinh21
    My med-surg text book says to "position the pt up right and deflate the tube cuff during meals because the cuff can ballon backwards and interefere with the passage of food through the esophagus."

    I think this also makes sense.

    If this is an nclex question....which answer would everyone else choose? Defate or inflate the cuff?
    It does make sense, but what is more important? "backing up of food?" or "preventing aspiration?"
  9. by   neil890123
    hmmmm its really confusing...some books have different opinions...but thing passes through the esophagus....not trachea right? so i think deflation is good in my opinion....imagine something pressing on your throat while would really create difficulty in swallowing which may trigger your gag reflex which will make food back flow and make the food go to the trachea instead which may cause aspiration also...... your epiglottis will still prevent food from going down the wrong hole....but thinking about it....inflate and deflate has different rationales also so both are right...maybe it depends on the patient and what the scenario is
  10. by   ridgeway
    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
  11. by   kellyRRT
    Trachs are cuffed so patient can be mechanically ventilated. They are NOT cuffed for eating or aspiration prevention purposes.

    If a patient is able to eat, a cuffless trach is best. PMV valves assist in breathing while eating. PMV valve allows patient to inhale through nose, mouth and trach (cuff MUST be deflated). Exhalation occurs through only the nose or mouth when patient is wearing PMV.

    Cuffs that are inflated when patient is ingesting whole foods pose a problem swallowing the food down the esophagus. Food must pass by an inflated cuff in the the trachea or windpipe which is directly in front of the esophagus.

    An inflated cuff, with a patient who is being tubefed or that has GERD can be of assistance in preventing food from aspirating into the lungs; but, preventing aspiration is by NO means the reason why the cuff is there in the first place.

    Hope you all got A's by now. Hopefully, Respiratory or Speech Therapy will be close by at feeding time to assist with your trached patients!!!!
  12. by   edge24bri
    Med line plus says that a person with a trach needs to deflate the cuff for swallowing purposes. But there are conflicting opinions and stats out there. So how do you answer a question like that if asked on NCLEX? Enquiring minds want to know.
  13. by   edge24bri
    Alright. Now that's a better answer. But how does NCLEX ask that question? And what do they expect as an answer when there are so many conflicting responses and information out there and in books.

    Sometimes I believe NCLEX is money making scam. Now don't go insulting me on here like I have seen so many do to others, because frankly, I'm too old to care what others think of me or say about me. This is simply a comment. Does anyone else out there think the same and are too afraid to state it?
  14. by   Salazartracy
    Inflating the cuff to prevent aspiration is a misconception! Aspiration starts at the vocal cords, if material have already passed the vocal cords and reached the inflated trach cuff, the patient has already aspirated regardless! By inflating the cuff ONLY just creates a resovoir. HOPES THIS helps. SALAZAR RT
    Last edit by Salazartracy on Nov 20, '17