Pediatric Tracheostomy

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  1. This is a discussion on Pediatric Tracheostomy in PICU Nursing / Pediatric, part of Critical Care Nursing ... Has anyone ever heard of air getting into a completely deflated trach cuff? As far as I know, no...

    by Dec 9, '11
    Has anyone ever heard of air getting into a completely deflated trach cuff? As far as I know, no one injected the air. This child has a trach that we were keeping the cuff filled with 1.5ml to 2 ml of sterile H2O, as ordered. Has been weaned down to no H2O in the cuff. Air was noticably in the cuff this morning, as the balloon was inflated. Balloon was completed deflated all day (8 hrs). Received a text a while ago as I am off duty, stating, FYI that cuff gets air in it somehow.
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    by katnursey Dec 9, '11 8:28 pm
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  3. 12 Comments so far...

  4. Dec 9, '11 by
    How was it discovered that the cuff had air in it?

    I've also never heard of trach cuffs being filled with water, just air. I imagine the water would create quite a problem if the cuff were to get a leak. Is this standard?

    To answer your orginal question- No, I have never heard of trach cuffs getting air in them unless they were injected with air. If the tubing where the air is injected into the cuff was not closed, I could see where it would be possible for some air to get in, but it shouldn't be a significant amount.
  5. Dec 9, '11 by
    How about changing out the trach and seeing if that stops it from happening? Otherwise, I'd wonder if the balloon is long enough that the child could get it into his/her mouth to chew on it. Stranger things have happened.

    If that isn't a possibility, maybe try "flag" taping the balloon port and initial, creating enough of a "barrier" to make people think twice about checking the balloon (if the child is on a vent and cuff volume is a box to check on the vent sheet) but not creating a barrier that could slow down access in case the cuff needed to be inflated in an emergency.

    Is this an inpt or home care situation?

    mm
  6. Dec 9, '11 by
    Quote from Ashley, PICU RN
    How was it discovered that the cuff had air in it?

    I've also never heard of trach cuffs being filled with water, just air. I imagine the water would create quite a problem if the cuff were to get a leak. Is this standard?

    To answer your orginal question- No, I have never heard of trach cuffs getting air in them unless they were injected with air. If the tubing where the air is injected into the cuff was not closed, I could see where it would be possible for some air to get in, but it shouldn't be a significant amount.
    Ashley, most trach cuffs I've worked with require sterile water, usually when the child is vent-dependent.
  7. Dec 9, '11 by
    The child is vent dependent. We were using the sterile H20 as ordered. I have never used air in a trach cuff. I discovered the air this morning when I was doing my nursing assessment. The ballon was inflated. I slowly began to deflate the cuff.....no water, all air. I thought, what the heck. I took care of him for 8 hours today and the cuff stayed deflated. I took care of him yesterday.....no air in the balloon. Thought it strange, now that I am at home and not there, that I receive a "FYI" text message that the cuff now has air in it somehow. I told them to contact their physician if they have a concern about the cuff, as I am off duty. The child can get the balloon/cuff port in his mouth if he wanted too, but does not chew and cannot blow. There is no tubing to close off. There is the inflation line with the balloon/cuff port at the end. It has a luer valve where a syringe screws on and is used to inflate or deflate the cuff. Like I said, I had no problem today or yesterday with air getting in. Just finding this very strange and thought if someone is not injecting the air, well maybe someone has heard of this happening.
  8. Dec 9, '11 by
    That happened to my kiddo too, randomly there would be air in his balloon. It never really concerned any of the nurses (or this parents) so I guess I never really thought anything of it.

    No idea why it happens though..
  9. Dec 10, '11 by
    Quote from NeoPediRN
    Ashley, most trach cuffs I've worked with require sterile water, usually when the child is vent-dependent.
    I'm learning lots of new things every day. I have taken care of very few kids who are chronically vent-dependent. I did some reading and it seems that trachs that use silicone cuffs should be inflated with sterile water. Other types of trachs may use water or air.

    I read that it's possible for air to diffuse out of the silicone membrane of the trach cuff. I wonder if it's also possible to air to diffuse into the trach cuff?
  10. Asst. Admin
    Dec 10, '11 by
    I think it would be highly improbable for air to diffuse from the relatively low-pressure tracheal lumen into the much higher-pressure cuff. It's possible that there's a hole in the cuff large enough for air to be aspirated into the pilot port. But that doesn't explain why katnursey wasn't aspirating air during her shift, only at the start, and that others were.
  11. Dec 11, '11 by
    Thank you for your responses. It will be interesting to see what I find Monday morning. I have my own thoughts about what is going on. Almost 100% sure air is not getting in there on its own. I found nothing wrong with the inflation line, balloon cuff port or luer valve. Strange that the balloon stayed completely deflated during my 8 hour shifts both Thursday and Friday. It is important for that cuff to remain completely deflated for the Passy-Muir Valve.
  12. Dec 13, '11 by
    Quote from katnursey
    Thank you for your responses. It will be interesting to see what I find Monday morning. I have my own thoughts about what is going on. Almost 100% sure air is not getting in there on its own. I found nothing wrong with the inflation line, balloon cuff port or luer valve. Strange that the balloon stayed completely deflated during my 8 hour shifts both Thursday and Friday. It is important for that cuff to remain completely deflated for the Passy-Muir Valve.
    It is imperative or the child will suffocate!