Cuffed Trached pt while eating..what to do?

  1. 0
    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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  3. 9 Comments so far...

  4. 0
    i think you suction and deflate the cuff. what was the rationale to the question that said to inflate the cuff?
  5. 0
    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?
  6. 0
    If pt has a cuffed tracheostomy tube, the cuff should be inflated a while when pt is eating to prevent aspiration.
  7. 0
    I would hope this one doesn't show up on the test. There seems to be a difference of opinion on what to do.
  8. 0
    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.
  9. 0
    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?"
  10. 0
    hmmmm its really confusing...some books have different opinions...but thing is....food passes through the esophagus....not trachea right? so i think deflation is good in my opinion....imagine something pressing on your throat while eating....it 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
  11. 0
    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
  12. 0
    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!!!!


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