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The St George Hospital Revised August 2003ICU Nursing Procedure Manual

Measuring Endotracheal / Tracheostomy Tube Cuff Pressure

LIMITATIONS FOR PRACTICE:

RN who has been instructed in this procedure.

AIM:

To measure the cuff pressure of endotracheal / tracheostomy tubes.

To ensure adequate seal without exerting unnecessary pressure on the trachealmucosa.

EXPLANATION:

Normal tracheal perfusion pressure is approximately 30mmHg (40cms H2O).

Maintaining the cuff pressure below 25cms H2O helps guard against tracheal

ischaemia and necrosis. It should be noted that tracheal perfusion pressure is lower inhypotensive patients. In all cases, inflate the cuff only until the leak has been

occluded (minimal occlusive pressure) to avoid any unnecessary pressure on the

tracheal mucosa.

EQUIPMENT:

2 x Cuff pressure manometer (kept in cardiac arrest trolley)

Endotracheal / tracheostomy tube

PROCEDURE:

1. Attach pressure gauge to pilot tube.

2. Measure cuff pressure. Pressure should be 25cms of H2O, let cuff down to normal limits. If a leak is

detected at this level, inflate the cuff to a level so that it wont leak and inform theMO.

5. Record pressure on flow chart.

Tube may have a faulty cuff and patient may need to be reintubated.

7/31/2019 Cuff Pressures v Am Stgeorge

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The St George Hospital Revised August 2003ICU Nursing Procedure Manual

FREQUENCY:

Cuff measurement attended:

at the beginning of each shift

after intubation

following gaseous anaesthesia

if cuff leak present

TROUBLESHOOTING:

PROBLEM POSSIBLE CAUSES ACTION

High cuff pressure >25cmsH2O.

1. High pressure, low volumecuffed endotracheal tube

(ETT) insitu, eg

Mallincrodt, Portex blueline.

2. High peak airway pressure.

3. ETT may be too small forparticular patient.

1. Maintain cuff seal. informMO. Patient will need

reintubation with low

pressure, high volume ETTif intubated for >24 hours.

2. Check for cause of high

pressure. Maintain cuffseal. Inform MO.

3. Maintain cuff seal. InformMO. Patient will need

reintubation with larger

ETT if to remain intubated.

Low cuff pressure