Pediatric Tracheostomy

Double-Helix, BSN, RN · Dec 10, 2011

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.

mercurysmom · Dec 10, 2011

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

NeoPediRN · Dec 10, 2011

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.

katnursey · Dec 10, 2011

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.

PediLove2147, BSN, RN · Dec 10, 2011

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..

Double-Helix, BSN, RN · Dec 11, 2011

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?

Pediatric Critical Care Columnist · Dec 11, 2011

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.

katnursey · Dec 11, 2011

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.

NeoPediRN · Dec 13, 2011

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!

Pediatric Critical Care Columnist · Dec 13, 2011

I ran your scenario past two of our very senior RRTs yesterday and they echoed my response, that there is no way for air to get into the cuff passively. It's highly suspicious...

katnursey · Dec 13, 2011

I ran your scenario past two of our very senior RRTs yesterday and they echoed my response, that there is no way for air to get into the cuff passively. It's highly suspicious...

Thank you for your response. I have worked the past 2 days and absolutely no air filled into the balloon on its own while I was on duty. I checked the balloon continuously throughout the day. However, both yesterday and today, when I arrived on duty, once again I noticed the balloon looked slightly inflated, more so this morning. I withdrew until it was completely deflated....no water, just air. The mom told me it is filling with air as the day progresses. I showed the balloon several times to her today, that it was completely deflated and NO air was seeping in there. She said it is happening in the evening. She also spoke to a RRT, who she said, informed her yes, air can get into the balloon....couldn't say how. All I know, is I have never seen this happen before when working with any child or adult with a trach.