Cutting Balloon cuffs

I too will ask a clinical question.....

I've always felt strongly about using a syringe to deflate the balloon. There are some I've noticed that have no problem simply cutting or ripping the cuff if a syringe is not readily available. I really notice this in PACU when the patient has just gotten there and is ready for extubation, PACU nurses get kind of impatient when you're grabbing for a syringe to deflate the balloon. How does everyone feel about this? I know that there are different situations where cutting the cuff could cause more problems (in the OR).

Never rip off the pilot balloon - use the syringe.

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i agree - use the syringe...i have seen the balloon cuffed ripped and the tubing occluded - and now - no way to deflate the balloon...

I agree, never rip the balloon off, use a syringe. Sometimes the cuff doesn't deflate well and you're pulling a inflated cuff through the cords, possibly damaging them.

I too will ask a clinical question.....

I've always felt strongly about using a syringe to deflate the balloon. There are some I've noticed that have no problem simply cutting or ripping the cuff if a syringe is not readily available. I really notice this in PACU when the patient has just gotten there and is ready for extubation, PACU nurses get kind of impatient when you're grabbing for a syringe to deflate the balloon. How does everyone feel about this? I know that there are different situations where cutting the cuff could cause more problems (in the OR).

I have ripped it off once or twice, but not as a routine practice of mine. The times I ripped it were when patients were struggling to be held down (extremely combative cranis who were ready to be extubated) and reaching for the syringe, whether a syringe to deflate the balloon or a syringe of propoful to get them down would have taken too long and possibly interefered with patient safety. But as a general rule, no.

i WOULD TELL THE PACU NURSE THAT YOUR FIRST CONSIDERATION IS YOUR PATIENTS SAFETY!!! ALWAY DEFLATE THE BALLOON.

I too will ask a clinical question.....

I've always felt strongly about using a syringe to deflate the balloon. There are some I've noticed that have no problem simply cutting or ripping the cuff if a syringe is not readily available. I really notice this in PACU when the patient has just gotten there and is ready for extubation, PACU nurses get kind of impatient when you're grabbing for a syringe to deflate the balloon. How does everyone feel about this? I know that there are different situations where cutting the cuff could cause more problems (in the OR).

well....your first problem is that you should be extubating your patients in the OR. :)

secondly, i wouldn't give a damm what the PACU nurse thought about how I extubated my patient.

One of the things that separates the great from the good anesthetists, is what I call The Art of Anesthesia. It is doing every technique artfully as well as skillfully. And, there is always a reason for everything you do.

The Art of Extubation is slowly deflating the cuff on the tube, comparing the amount you remove from the amount you put in (it will probably be more if you used nitrous oxide), and even deflating it more for a smooth extubation. If you do this right, you rarely have a post-extubation laryngospasm.

In the very rare situation where you may have to reintubate, the tube is intact and you save time in getting a new one ready.

In my practice, it is important that the patients do not buck on the tube, so I take my time with deflating the cuff slowly, let the patient get used to the change in tracheal pressure for a few breaths, then extubate.

I don't work with ICU nurses and do my own extubations, but if I did and had a nurse cut a cuff, we would have a "sit-down" (old Sicilian term) and I could guarantee it would not be done again on one of my patients.

Cowboys and Cowgirls should stay on the farm and not work with people.

Yoga

Saw the "balloon rip" too many times. Always asked "Why?" Usual answers: just easier, saves time, what's the diff? Only thought provoking answer: semi-inflated cuff pulls secretions out of the trachea. My response: "Yeah, pulls out secretions, not to mention the vocal cords." How can anyone be sure all that volume in the cuff (especially after nitrous) will be gone by the time you draw the tube up the trachea 2 inches and through the cords? Agreed: truly poor, lazy patient care practice.

you risk not being able to deflate your balloon if you 'rip' or pull your cuff off instead of deflating. when you pull a cuff off, it stretches the plastic. this stretching of the plastic generates heat. due to the narrowness of the diameter, pulling the cuff off can generate enough heat to immediately seal the end of the cuff access. doesn't happen all the time, but it is a definite possibility.

I agree, never rip the balloon off, use a syringe. Sometimes the cuff doesn't deflate well and you're pulling a inflated cuff through the cords, possibly damaging them.

Although i said i was never posting in this forum again, i did have to respond to this thread. I gree with the above quote. We had an anesthesiologist who did this a lot, and only when someone's chords were danaged did he stop doing it.

About 6 months ago the RT and I extubated in the ICU with the pulmonologist sitting outside the room writing on the chart. When he saw that I had deflated the cuff with the syringe, he said that in the future that he wanted the balloon left inflated--so as to draw out the secretions on top of the cuff.

We just looked at each other with that knowing "what an idiot" look!