How to measure tracheostomy tube cuff pressure

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Rationale and key points

This How to module explores the process and principles of measuring tracheostomy tube cuff pressure and the associated evidence base. It discusses the indications for tracheostomy tube cuff pressure measurement and identifies potential complications associated with the procedure.
  • Regular measurement of tracheostomy tube cuff pressure is essential to prevent complications associated with tracheostomy tube placement.
  • Tracheostomy tube cuff pressure should be between 20mmHg and 25mmHg.
clinical procedures, clinical skills, respiratory, tracheostomy, tracheostomy tube

Learning objectives

After reading this module, you should be able to:
  • Identify the preparatory steps and the equipment used to measure tracheostomy tube cuff pressure.
  • Describe the procedure for measuring tracheostomy tube cuff pressure.
  • Identify the risks involved and the safety measures to be taken when the cuff pressure is high or low.

Procedure
  1. Attach the cuff pressure manometer to the pilot balloon of the tracheostomy tube.
  1. Note the pressure reading, which should be 20-25mmHg.
  1. If it is not, adjust the pressure reading to 20-25mmHg by inflating the cuff with air to increase the pressure, or by removing air from the cuff to decrease the pressure. A 10mL syringe may be used to remove air from the cuff, or the air can be removed directly using certain cuff manometers.
Figure 1
Figure 1.Optimum stethoscope position to check for escaping air
  1. Use the stethoscope to check for noise of escaping air at the suprasternal notch (Figure 1). This suggests that the seal between the tracheal mucosa and the tracheostomy cuff is not complete. If necessary, add air to the pilot balloon until the leak can no longer be heard and recheck the tracheostomy tube cuff pressure.
  1. Complete a respiratory assessment and ensure that the patient is comfortable.
  1. Remove the gloves and apron and wash and dry your hands.
  1. Clean the cuff manometer according to local guidelines.
  1. Document the procedure and findings in the patient’s notes.
  1. Raise any concerns with an appropriate senior practitioner.

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