Once you have these pictures in your mind of what a trach looks like in the trachea and how the air flow works with an uncuffed vs a cuffed tracheostomy, you will feel a lot more secure in what you are doing.
First, there are several types of tracheostomies:
So a patient who can't breathe for themselves, is on a ventilator that forcibly pushes air into the lungs. Without a cuff inflated, some of the air would go up and out his nose and mouth, therefore less oxygen absorbed by the lungs.
With the cuff inflated, there is nowhere for the air to go but down into the lungs.
The cuff is not inflated for the purpose of "anchoring" the trach in the throat. It is only to direct the flow of air.
If you put a passey muir (one way valve) on a trach and left the cuff inflated, the patient would be able to breathe in, but the passey muir valve would close as he tried to breathe out.
There would be no place for the air to go. He would would not be able to exhale.
I haven't seen any other brand of valve used in years. It's always the Passey Muir.
The Passey Muir allows the patient to still get the benefit of a trach for inspiration of adequate air and oxygen but redirects the air on exhalation for speech and swallowing.
OK, I really had to think this through...
If a patient is on a ventilator:
with a cuffed tracheostomy: the air would go only into the lungs and out the trach
with a deflated cuff or uncuffed tracheostomy: the air would go partially down the lungs, partially up and out the nose and mouth on inspiration. On expiration, the air would exit partially out the trach and partially out the nose and mouth.
with the Passey Muir valve and an uncuffed trach: the air would go partially down the lungs, partially up and out the nose and mouth on inspiration. This is the same as an uncuffed trach. On expiration, the air has to exit out the nose and mouth. This helps maintain the function of the upper airway better than a plain uncuffed trach.
Whew! Got it!
The inflation of the cuff must be by doctor order or standing order at a facility with a specified amount of air. For example: 5 mls air injected by syringe, or a gauge (pictured below) just like a BP cuff with a specified amount of pressure against the cuff.
You can’t just guess something is adequately inflated.
In most situations, other disciplines would also be involved in the determination of types of trachs, inflation settings, etc etc. These disciplines, in addition to the physician, would most likely be respiratory therapy and speech therapy. So you won't be going it alone.
You can tell if a cuff is inflated or deflated by looking at the little balloon at the end where you attach the syringe. It will have some air in it and is “squishable”. A deflated cuff has a flat balloon and nothing to squish.
The fenestrated tracheostomy tube allows even more air to pass up through the larynx, nose and mouth. However, I wouldn’t trust leaving a fenestrated trach cuffed for breathing purposes because it is a pretty small window that could get clogged with sputum.
Passey Muir: A brand of one way valve placed on the end of the tracheostomy tube for patients who are capable of speech.
Fenestrated: (how to pronounce) windowed. A hole in the trach is a window allowing air to pass beyond the trach tube
For additional information on an uncuffed vs cuffed tracheostomy, click here.
Trach care remains the same regardless of type. They all have inner cannulas that are cleaned regularly in the same manner.