Pt. With trach: cuffed but always deflated?

Mossback · Jul 13, 2017

The purpose of the cuff is not to limit airflow around the teach, but to prevent secretions from moving down the trachea and into the lungs.

Unless the patient is actively bleeding, the coff is deflated following surgery and the recovery from anesthesia.

An inflated cuff can collect a large amount of secretions above it that will, at some point, descend into the lungs. It can also erode the delicate mucus membranes that line the trachea. For these reasons, it is customary to deflate the cuff as soon as the patient recovers the ability to cough up and control secretions.

Here's hoping all goes well with your son.

vanilla bean · Jul 13, 2017

Inflating a trach cuff forms a barrier between the upper and lower airway. Inflate the cuff, and *all* air movement in and out of the lungs is through the trach tube. Deflate the cuff, and air in and out of the lungs can move through the trach tube *and* through the upper airway (nose/mouth). Allowing exhaled air to pass into the upper airway allows for vocalization and speech because that air is allowed to pass through the vocal cords (which cannot happen when the cuff is inflated).

Determining when and why to inflate or deflate a trach cuff depends on why it is in place to begin with and what it is being used for. Why is your patient trached? Is the patient vent dependent either all or part of the time? Is the patient at risk for aspiration or does s/he have trouble protecting his/her airway at times?

vanilla bean · Jul 13, 2017

The purpose of the cuff is not to limit airflow around the teach, but to prevent secretions from moving down the trachea and into the lungs

This is *one* reason for an inflated cuff. It is not the only reason.

An inflated cuff can collect a large amount of secretions above it that will, at some point, descend into the lungs.

This is true, particularly if the patient has an impaired swallow. Oral hygiene is extremely important to prevent aspiration of secretions and infections.

It can also erode the delicate mucus membranes that line the trachea.

This is also true, but a *properly* inflated trach cuff decreases this risk.

RNNPICU, BSN, RN · Jul 13, 2017

As Vanilla bean very nicely stated, an inflated cuff will direct air in and out of the trach itself. A deflated cuff allows some air to flow around the trach. Again, this is important for vocalization, weaning from a ventilator, preparing for decannulation. It is important to understand why your patient has a trach and that can help you understand why your patient would need a cuffed trach vs uncuffed.

Three things to remember, if your pt eats by mouth, a deflated cuff will be important as it would affect swallowing and breathing during eating.

Always deflate the cuff before removing the trach during a trach change, and ensure the cuff is deflated during insertion.

Orion81RN · Jul 14, 2017

The purpose of the cuff is not to limit airflow around the teach, but to prevent secretions from moving down the trachea and into the lungs.
Unless the patient is actively bleeding, the coff is deflated following surgery and the recovery from anesthesia.
An inflated cuff can collect a large amount of secretions above it that will, at some point, descend into the lungs. It can also erode the delicate mucus membranes that line the trachea. For these reasons, it is customary to deflate the cuff as soon as the patient recovers the ability to cough up and control secretions.
Here's hoping all goes well with your son.

Thank you! It is a patient of mine in private duty

Orion81RN · Jul 14, 2017

As Vanilla bean very nicely stated, an inflated cuff will direct air in and out of the trach itself. A deflated cuff allows some air to flow around the trach. Again, this is important for vocalization, weaning from a ventilator, preparing for decannulation. It is important to understand why your patient has a trach and that can help you understand why your patient would need a cuffed trach vs uncuffed.
Three things to remember, if your pt eats by mouth, a deflated cuff will be important as it would affect swallowing and breathing during eating.
Always deflate the cuff before removing the trach during a trach change, and ensure the cuff is deflated during insertion.

My patient was on a ventilator 7 months ago. She does not speak and would aspirate if given anything by mouth. Feeding is through J-tube. So I'm basically not understanding why she has a cuff at all. Perhaps because they had hoped for her to start eating. 4 months ago (before I started working the case,) there were orders for taste tests, but unfortunately she cannot handle anything P.O.

meanmaryjean, DNP, RN · Jul 15, 2017

My patient was on a ventilator 7 months ago. She does not speak and would aspirate if given anything by mouth. Feeding is through J-tube. So I'm basically not understanding why she has a cuff at all. Perhaps because they had hoped for her to start eating. 4 months ago (before I started working the case,) there were orders for taste tests, but unfortunately she cannot handle anything P.O.

Probably they just never switched her to uncuffed. A deflated cuff is not doing any harm, trachs are expensive, so use what is on hand. See this all the time with kids who are weaned from the vent in home care.

heinz57 · Jul 15, 2017

The cuff does very little to prevent aspiration since it is located below the glottis. The exception might be one with a subglottic suction port.

Trachs are expensive. BUT, a cuffed trach, whether it has been inflated or deflated, should be changed out every 30 - 60 days.

Other reasons for no trach change:

The doctor managing the patient may have no clue about trachs.

No one caring for this patient may have the training to change the trach.

No one mentioned it in a plan of care.

Pt has been written off as a "why bother?".

Proper cuff inflation is difficult to determine with positive pressure for a minimal leak technique or a manometer.

Orion81RN · Jul 15, 2017

The cuff does very little to prevent aspiration since it is located below the glottis. The exception might be one with a subglottic suction port.
Trachs are expensive. BUT, a cuffed trach, whether it has been inflated or deflated, should be changed out every 30 - 60 days.
Other reasons for no trach change:
The doctor managing the patient may have no clue about trachs.
No one caring for this patient may have the training to change the trach.
No one mentioned it in a plan of care.
Pt has been written off as a "why bother?".
Proper cuff inflation is difficult to determine with positive pressure for a minimal leak technique or a manometer.

Yeah, we change her trach every week. Its not one with an inner cannula.

Home Health Columnist / Guide · Jul 15, 2017

Check out Aaron's Tracheostomy Page for up to date info on trach care along with the resources section: Surgical Procedures

Critical pointers: Tracheostomies

AN's Pulmonary Nursing sectionhas many resources too.

RNNPICU, BSN, RN · Jul 19, 2017

Trachs, especially in pediatrics should be changed weekly, but check your patient's orders. It may be that the ENT or Pulmonologist may need to be reminded about the cuffed trach and see if the patient could be switched to an uncuffed trach.