need help with a trach question

[leetraumarn]

help please i'm in a real jam. i work in a dedicated trauma icu 23 bed at a level 1 trauma center and we have stirred up a huge debate. when a pt has a trach and goes from a vent to a atc do you or do you not deflate the cuff?? there seems to be ongoing struggle as to what is right all of a sudden. i have been nursing for 4 years and have always let the cuff down and now my new resident swears you leave it up?? i can see leaving it up when a pt is eating but otherwise aren't they at a increased risk of plugging off if the cuff is up?? thanks in advance for your input.

[OC_An Khe]

What was the "new" residents rationale for leaving the cuff up? Did you receive a good explanation for the order? How fresh was the trach, does the patient have a good gag and cough reflex?

[This message has been edited by ocankhe (edited January 17, 2001).]

[leetraumarn]

+ gag & projectile cough. the trach is at least 8 days old. his rationale was thats the way i have always done it. i really wasnt trying to question his authority but it went against everything i have learned in my short career. i just wanted some input from others and make sure things havent changed>> thanks for the reply

[goldilocksrn]

I always keep trach and vent patient's cuffs DEFLATED unless they are eating or at risk for aspiration. From what I am understanding, the more time that a cuff is inflated, the less protective it becomes when needed.

[Charles S. Smith, RN, MS]

There are several key possibilities here. First, look at your procedure standards as the guideline. If your procedure is for deflation, then do so and educate your resident. Second, look to the literature for non-vented trach patients for the most current research. There are reasons for and against deflation. The best reason for deflation is to prevent unnecessary pressure against the tracheal wall that could cause erosion. If this is a long term trach, you definitely want to decrease pressure. If it is short term, you want to get the patient used to breathing less through the "straw", especially if the patient is eventually going to have the trach size weaned down over time so it can close. The best reason for keeping the trach cuff inflated is to prevent aspiration. If the patient is not handling his secretions well and does not have a strong cough, you might try timed cuff deflation trials. Of course, inflate when eating or drinking.

Many times MDs and RNs practice what i call "witchcraft" a euphemism for "the way we have always done it. Look to the literature for expert and scientifically based rationale so you can educate your resident and others.

regards

Chas