Use the minimal-leak method instead. Described below.
In a recent blog, I got lots of hits but very few clicks on the actual video. I decided to rewrite this to focus only on this one specific issue.
Here is a policy and procedure from a major teaching hospital in Texas, USA.
UTMB RESPIRATORY CARE SERVICES PROCEDURE – Minimal Occluding Volume (MOV) or Minimal Leak Technique Policy 7.3.49 Page 1 of 4 Minimal Occluding Volume (MOV) or Minimal Leak Technique Formulated: 11/92 Effective: 11/02/94 Revised: 11/03/14
Continued next page
|Minimal Occluding Volume (MOV) Purpose||To standardize the method of minimal volume of air in the endotracheal/tracheal cuff that will allow optimal sealing of the airway.|
|Scope|| All intubated patients will be assessed for proper volume/pressure in endotracheal cuffs with each ventilator assessment.
All tracheostomy patients not utilizing a foam-filled (bivona type) cuff volume/pressures will be monitored on a routine basis.
The acceptable intra-cuff pressure is less than 25 mmHg.
|Audience||Respiratory Care Practitioners employed by the Respiratory Care Services Department with the understanding of age specific requirements of the patient population.|
|Equipment|| 10cc syringe
Cuff pressure manometer
Three-way stop cock
OR Cufflator cuff inflation device
Manual resuscitator and mask
|1||Technique for MOV
Suction the patient airway and oral pharynx to prevent possible aspiration of retained secretions.
Place your stethoscope diaphragm over the laryngeal area and inflate cuff until all air leak is gone.
For Positive Pressure Ventilation, remove small increments (0.25-0.50cc) of air from the cuff until a small leak is heard at the point of peak inspiratory pressure (PIP). Check tidal volume to insure adequate ventilation and inflate cuff until all air leak is gone.
For spontaneous ventilation or CPAP, remove small increments of air (0.25-0.50cc) from cuff until a small expiratory leak is heard (usually in early or mid exhalation). Inflate until all air leakage is gone.
Here is a video showing exactly how to do it:
What if you use too much air?
Using the 10 cc is wrong because it causes “tracheal malacia” and post-extubation stridor. the trachea gets stretched at the point of balloon contact and collapses when air moves out. It can also contribute to tracheal-esophageal fistula. In other words, too much air in the cuff will harm the patient.