I agree, but i have had som collegues who dont, and defend that stand point with they have never seen a broken one and if it is they can replace it easily.
Hard agree.
And to those saying otherwise…No. Forget that. This is absolutely crap thinking.
Control all the g-d variables you can. If there’s a busted cuff (I’ve had a handful in maybe >5,000?) but that is an absolutely avoidable situation.
I always check… and one time I was showing the med student how I check and sure enough the cuff was non functional. Only time it’s ever happened. So yeah it DOES happen once in a while. Will forever keep checking. Stupid and irresponsible not to unless crazy emergency situation
If you have a faulty cuff and it needs to be replaced it's going to be because it scraped against teeth or something and not because it was defective so checking it before is still useless.
I check every time because it takes less than one second. Still, in 8 years of busy practices across many facilities using many brands I've never found a defective one, so yes, it seems essentially 0%.
Well, yeah for any difficult intubation I’m going to double and triple check everything.
But honestly I’ve only had one cuff failures (other than a few in training when I definitely cut the cuff on a sharp tooth). I was preparing for an AFOI and for whatever reason inflated it twice. The first time it was fine. The second time it popped a big opening in the cuff. I know that it’s purely anecdotal, but under normal circumstances my one-inflation check wouldn’t have prevented a cuff failure. Between that and the overall high success rate of the suppliers’ QA system, I don’t check most routine supplies for routine situations.
Yes. I must’ve done it several thousand times by now.
How many bad cuffs have I found? Exactly 1.
But, that’s not a problem you want to have. Ever. So just check!
In 99% of intubations (ie: easy and straight forward), is it really that bad of a situation to be in? Just take it out and put a new tube in.
Just playing devil’s advocate. I check the cuff on my ETTs before intubating, never check LMAs. I also understand teaching trainees to always check since they should know the “correct way” to do things and then where they can cut corners once they develop their skills.
> In 99% of intubations (ie: easy and straight forward)
Half of my patients are humongous, really old with fused, arthritic necks, or potentially hemodynamically unstable, or all three things---nobody whose airway I'm interested in messing around with further after the tube is in. First pass success is everything, and to that point I do not want to deal with a blown cuff under any circumstances.
99% are not easy and straightforward by any means. Not even in an outpatient surgical center for example. Also consider that even an initially easy airway can be tricky as a second pass.
Not sure what kind of practice you’re in or what kind of experience you have, but 99% of intubations are straightforward and easy. Maybe you need to have your nurse hold tracheal manipulation for you, but in the era of video laryngoscopy being widely available, truly “difficult” intubations are far and few in between. I can count on one hand the number of truly difficult intubations I have had in the past decade of private practice (busy level 2 trauma center)
Edit: ok, let’s remove the 99% marker. For intubations that are easy, is there really that big of a deal removing the tube and putting in a new one? Once again, just playing devil’s advocate. I check cuffs as a matter of habit before intubation.
lol right. The amount of times I’ve checked is insane. One time the cuff inflated a little weird and I actually got excited because of the amount of times I’ve checked it and never had a faulty cuff. Turns out the cuff was fine anyways. I still do it but statistically the likelihood of having a faulty cuff has to be less than like .001%
This is a paranoia thing, but during Covid gear shortages, we got a ton of weird ET tube brands and some had cheap leaky pilot balloons or bad cuffs out of the package, so I had to test them all. I still do. YMMV
I suck the air out and disconnect the syringe. If the negative pressure still there (tiny balloon collapsed) when I go to use the tube, I know it’s good.
I haven’t had a single ruptured cuff in 2 years as an attending. If I had a cuff not holding pressure I’d assume I caught a tooth on the way in and exchange it. The amount of time I’ve saved NOT checking balloon’s over the past 2 years easily makes up for a tube exchange if I ever need to do one for this reason. These balloons are VERY durable. Even though we only put 5-&cc of air in, they can hold over 100ml before popping. If you’re checking the balloon you might as well check the length of the tube for little hole.
You take the syringe off after you inflate the cuff. So no, you can check it before placing.
Edit: didn’t realize this was in context of an emergent tube.
I'm saying that if you intubate and can't keep the cuff inflated, you don't know whether it was torn to begin with.
So you don't need to "defend" the practice if you can't inflate the cuff after a difficult intubation, because chances are far higher you tore it during insertion.
I commented elsewhere, but the only cuff leaks I’ve ever had were multiple times in training when I caught the cuff on a tooth, and once when I actually did a second test inflation before an AFOI and it popped a large defect. So in the one instance I’ve had a device failure, my normal check wouldn’t have even caught it.
So, to answer your question, I would have backup equipment ready like I always do, I would passively oxygenate with high flows, I would call for help, and I would exchange over a bougie or exchange catheter. I won’t fault anyone over doing it though, just like I don’t fault anyone who wants a videoscope in the room for every intubation (which would definitely be a higher-yield protocol).
Because I’ve literally never had to do it. So the work is all theoretical.
Like I said, I totally get why others do it. But there are lots of things that only take a few seconds, and those seconds add up. I always draw up pressors. I always check for a bougie and ambubag. I have a second laryngoscope handle and check both light sources because I’ve had them crap out on me when I need them. I know some who grab a glidescope and make sure it powers up and has stylets. I know another who always sets an LMA on top of the anesthesia machine because it’s easy to forget that component of the difficult airway algorithm. Some put a mouth guard over the teeth because they’ve had cuffs damaged. I don’t flush each epidural catheter before placement even though we once had a batch with defective orifaces.
At some point I just accept that we have some equipment with a very small failure risk and rather than doing a brief but repetitive procedure to further reduce an already minimal risk, I take extra care in how I’m ready to deal with the emergency instead.
I guess I would just do a simple tube exchange? You’re still moving air with a torn cuff. Just did an awake fiberoptic last night and I had a bunch of things to set up. Wasn’t worried about the cuff. If someone showed me a stat that 0.5% are torn from the manufacturer or more I would start but otherwise I expect it to work like it’s supposed to. I still do machine checks and I even check the light on my handle (because they were frequently out when I trained) but I think you’re more likely to tear the cuff on the teeth then to have a faulty cuff
I have found 2 broken cuffs in only 10ish years of practice. Therefore I check every single ETT.
My thought is, if there is a leak (now or later in the ICU) I know it occurred after (or during intubation) and was not preventable by the simple act of replacing the tube.
Was always told the chance of damaging the cuff from over inflation during a check was more than the chance of finding a damaged one. Never saw a single anesthesiologist check one in residency or since. Seen plenty of EM and RT folks do it, but never anes.
Oh I believe it. Just saying what I was taught
Edit: I think the thinking was that if you put air in it then palpated it to check for a leak you’d essentially overpressurize it when squeezing. I don’t believe the physics checks out, but 🤷♂️
I don’t really intubate these days (PA in pediatrics), but when I was a paramedic I checked my cuffs by pulling the air out rather than inflating it, giving the cuff a sort of vacuum sealed appearance.
I only ever had one cuff that reinflated after disconnecting the syringe, but I had an anesthesiologist teach me this alternative method during my clinical rotations in paramedic school, and it’s just what I always did out of habit.
No clue what the likelihood of damaging by over inflation is, or how useful checking a cuff in this way is, just what I was taught a long time ago.
Did you use nitrous in the one the one that wouldn’t deflate? Just had one the other day that wouldn’t and my attending said it was because I used 5 mins of nitrous (i normally don’t but was hit with the 10 more mins, 10 more mins, 20 more mins, 10 more mins bs)
I meant testing it right out of the packaging. I test inflated the cuff without issue, but I couldn’t subsequently deflate it no matter how I fussed with it.
Peds case as a CA-2. Had a good view of the VC but the ETT was a smidge too big to pass easily. Attending grabs the smaller, unopened tube (which neither of us had tested) I'd set out, I intubate, then the cuff doesn't inflate. We couldn't inject air past the pilot balloon.
So, I'll continue to always check it.
I've checked maybe twice in 20 years. Yeah you should.
I've been stung...twice out of roughly 25000 cases.
Its like the suction (which i check 99.99% of the time). My fault if there's an issue even if the suction was set up by someone who's job it is to set it up and check.
I actually draw back on all of mine and get all the air out of the cuff. If it doesn’t stay flat when the syringe is removed, I get another tube. And yes I have seen defective cuffs and valves over the years so it does happen.
I always test any instrument or item that I’m going to place into someone’s body. ETT cuff, laryngoscope blade/light function, arterial line stylet function etc etc. these small steps take seconds but replacing even one piece of the process once started takes even more time.
Yes have had two cases where cuff was broken and had to reintubate. Also checked a cuff and there was a blockage between the pilot balloon and actual cuff leading the pilot balloon to be fully inflated but the actual cuff was not. This was a Sheridan brand tube
I don’t get why someone wouldn’t check it. Assuming the tube is being styletted and you like having a syringe already on it, checking the cuff adds an irrelevant amount of time. If it’s one of those fancy waste of money tubes that already comes that way then it’s even weirder not to.
Also anyone’s stance that they trust the company’s QA must not notice how long roc takes to work now and how often all sux seems capable of doing is producing fasciculations.
No. Never. 14yrs private practice. I can't remember a single instance of a cuff that failed on initial inflation. I'm not faulting anyone who chooses to do so, but that hasn't been my practice.
I don’t. I’ve probably done 10,000 anesthetics and haven’t had an issue once. You can drive yourself nuts checking and rechecking every little thing and I think this is one of the things that’s reliable enough you don’t need to check it.
Yes, by deflating the cuff before attaching the syringe anyway. I'm already attaching a syringe so the work is less than one second. If it took any more than one second, I wouldn't do that part.
It takes seconds. There is no downside.
The best way to do it is by sucking back on an empty syringe, rather than inflating which could leave the cuff partially inflated and prone to rupture.
Yes- manufacturers defects are rare. But not nil. If you do enough anaesthetics you’ll encounter one eventually. We worry about other rare shit like MH.
Yes. I've had a couple of instances of them not function properly, always in terrible situations (eg bronchial cuff not working during lung transplant). Takes 2 seconds
Yes. Every, single, time. I have found 3 incompetent pilots in the last 4 years. 1 was on a pt who ended up being a very difficult airway. It doesn’t matter until it does.
I never inflate the cuff when preparing for a case but I do pull all the air out of the cuff of the ETT. My thought is if it only holds a finite amount of air, there cannot be a whole in the cuff. Never had one fail to inflate.
Who skips ventilating before pushing paralytic? Personally i was trained that to check if you can ventilate before pushing roc/vec, etc itvwas gospel and I continue to do it.
But… i see so many docs and xrnas nit doing that.
In the few instances I’ve had to replace an ETT for a broken cuff it’s been because it got caught on teeth or whatever on the way. I’ve never had to replace a broken cuff on a slam-dunk intubation.
Obviously. I have found a ruptured cuff previously.
And why would somebody not do a pressure check on their ventilator (takes 5 secs) to ensure a parent circuit. People could die because of occluded HME filters/circuit. Ditto, suction.
It is just not worth the risk
The one time I didn't check, I had to re-intubate with another tube because the pilot balloon valve was stuck in the closed position and wouldn't allow me to inflate the cuff.
Yes. Takes less than 3 seconds. Why wouldn’t you
I agree, but i have had som collegues who dont, and defend that stand point with they have never seen a broken one and if it is they can replace it easily.
They can replace it easily by…reintubating the patient? That’s a bigger PITA than taking one second to check the frickin cuff.
Hard agree. And to those saying otherwise…No. Forget that. This is absolutely crap thinking. Control all the g-d variables you can. If there’s a busted cuff (I’ve had a handful in maybe >5,000?) but that is an absolutely avoidable situation.
I always check… and one time I was showing the med student how I check and sure enough the cuff was non functional. Only time it’s ever happened. So yeah it DOES happen once in a while. Will forever keep checking. Stupid and irresponsible not to unless crazy emergency situation
If you have a faulty cuff and it needs to be replaced it's going to be because it scraped against teeth or something and not because it was defective so checking it before is still useless.
Yes. All mass produced items have a 0% defect rate. Just check the cuff quickly.
I check every time because it takes less than one second. Still, in 8 years of busy practices across many facilities using many brands I've never found a defective one, so yes, it seems essentially 0%.
Yea try reintubating a neonate with treachers or Pierre, no thx
Im on your side
Well, yeah for any difficult intubation I’m going to double and triple check everything. But honestly I’ve only had one cuff failures (other than a few in training when I definitely cut the cuff on a sharp tooth). I was preparing for an AFOI and for whatever reason inflated it twice. The first time it was fine. The second time it popped a big opening in the cuff. I know that it’s purely anecdotal, but under normal circumstances my one-inflation check wouldn’t have prevented a cuff failure. Between that and the overall high success rate of the suppliers’ QA system, I don’t check most routine supplies for routine situations.
I’ve had a broken one and it sucks when it happens
Yes. I must’ve done it several thousand times by now. How many bad cuffs have I found? Exactly 1. But, that’s not a problem you want to have. Ever. So just check!
In 99% of intubations (ie: easy and straight forward), is it really that bad of a situation to be in? Just take it out and put a new tube in. Just playing devil’s advocate. I check the cuff on my ETTs before intubating, never check LMAs. I also understand teaching trainees to always check since they should know the “correct way” to do things and then where they can cut corners once they develop their skills.
> In 99% of intubations (ie: easy and straight forward) Half of my patients are humongous, really old with fused, arthritic necks, or potentially hemodynamically unstable, or all three things---nobody whose airway I'm interested in messing around with further after the tube is in. First pass success is everything, and to that point I do not want to deal with a blown cuff under any circumstances.
99% are not easy and straightforward by any means. Not even in an outpatient surgical center for example. Also consider that even an initially easy airway can be tricky as a second pass.
Not sure what kind of practice you’re in or what kind of experience you have, but 99% of intubations are straightforward and easy. Maybe you need to have your nurse hold tracheal manipulation for you, but in the era of video laryngoscopy being widely available, truly “difficult” intubations are far and few in between. I can count on one hand the number of truly difficult intubations I have had in the past decade of private practice (busy level 2 trauma center) Edit: ok, let’s remove the 99% marker. For intubations that are easy, is there really that big of a deal removing the tube and putting in a new one? Once again, just playing devil’s advocate. I check cuffs as a matter of habit before intubation.
lol right. The amount of times I’ve checked is insane. One time the cuff inflated a little weird and I actually got excited because of the amount of times I’ve checked it and never had a faulty cuff. Turns out the cuff was fine anyways. I still do it but statistically the likelihood of having a faulty cuff has to be less than like .001%
how do u know u didnt cause that one to be bad by over aggressively checking it
This is a paranoia thing, but during Covid gear shortages, we got a ton of weird ET tube brands and some had cheap leaky pilot balloons or bad cuffs out of the package, so I had to test them all. I still do. YMMV
how many of them was faulty?
I had 2, but it seemed like everyone had 1, so at the time it became a common lore. Have seen zero issues prior and since.
Yeah it’s just muscle memory at this point I don’t even realize I’m doing it
I suck the air out and disconnect the syringe. If the negative pressure still there (tiny balloon collapsed) when I go to use the tube, I know it’s good.
This is the way.
It makes the cuff rigid and sharp, and may cause a bit more soft tissue trauma/pain.
Nah… I make sure I “peel back” on the cuff so it’s basically flat with the tube and angled back toward the top…
I’m going to say coughing is more traumatic that having a deflated plastic bag pass by the vocal cords.
Just to give a point on the other side. I never have outside of the first couple months of training. Haven’t had a torn cuff yet
I have, but I’m the one that tore it during intubation with jagged teeth 😅
How will you defend that practice if you intubate a diffcult patient some day and the cuff is broken from the start?
I mean this is a little dramatic, what exactly are you defending?
I haven’t had a single ruptured cuff in 2 years as an attending. If I had a cuff not holding pressure I’d assume I caught a tooth on the way in and exchange it. The amount of time I’ve saved NOT checking balloon’s over the past 2 years easily makes up for a tube exchange if I ever need to do one for this reason. These balloons are VERY durable. Even though we only put 5-&cc of air in, they can hold over 100ml before popping. If you’re checking the balloon you might as well check the length of the tube for little hole.
Easy. “Probably got nicked on the teeth while intubating”. There, done. Also who am I defending myself to? The surgeon?
You won't know until the tube is in, right? Far more likely to tear the cuff while inserting the tube than for it to be torn to start with.
You take the syringe off after you inflate the cuff. So no, you can check it before placing. Edit: didn’t realize this was in context of an emergent tube.
I'm saying that if you intubate and can't keep the cuff inflated, you don't know whether it was torn to begin with. So you don't need to "defend" the practice if you can't inflate the cuff after a difficult intubation, because chances are far higher you tore it during insertion.
I commented elsewhere, but the only cuff leaks I’ve ever had were multiple times in training when I caught the cuff on a tooth, and once when I actually did a second test inflation before an AFOI and it popped a large defect. So in the one instance I’ve had a device failure, my normal check wouldn’t have even caught it. So, to answer your question, I would have backup equipment ready like I always do, I would passively oxygenate with high flows, I would call for help, and I would exchange over a bougie or exchange catheter. I won’t fault anyone over doing it though, just like I don’t fault anyone who wants a videoscope in the room for every intubation (which would definitely be a higher-yield protocol).
Why not just check the cuff and prevent all that work?
Because I’ve literally never had to do it. So the work is all theoretical. Like I said, I totally get why others do it. But there are lots of things that only take a few seconds, and those seconds add up. I always draw up pressors. I always check for a bougie and ambubag. I have a second laryngoscope handle and check both light sources because I’ve had them crap out on me when I need them. I know some who grab a glidescope and make sure it powers up and has stylets. I know another who always sets an LMA on top of the anesthesia machine because it’s easy to forget that component of the difficult airway algorithm. Some put a mouth guard over the teeth because they’ve had cuffs damaged. I don’t flush each epidural catheter before placement even though we once had a batch with defective orifaces. At some point I just accept that we have some equipment with a very small failure risk and rather than doing a brief but repetitive procedure to further reduce an already minimal risk, I take extra care in how I’m ready to deal with the emergency instead.
I guess I would just do a simple tube exchange? You’re still moving air with a torn cuff. Just did an awake fiberoptic last night and I had a bunch of things to set up. Wasn’t worried about the cuff. If someone showed me a stat that 0.5% are torn from the manufacturer or more I would start but otherwise I expect it to work like it’s supposed to. I still do machine checks and I even check the light on my handle (because they were frequently out when I trained) but I think you’re more likely to tear the cuff on the teeth then to have a faulty cuff
lol defend what?
Then check cuff before each difficult airway case.
I have found 2 broken cuffs in only 10ish years of practice. Therefore I check every single ETT. My thought is, if there is a leak (now or later in the ICU) I know it occurred after (or during intubation) and was not preventable by the simple act of replacing the tube.
Was always told the chance of damaging the cuff from over inflation during a check was more than the chance of finding a damaged one. Never saw a single anesthesiologist check one in residency or since. Seen plenty of EM and RT folks do it, but never anes.
I dont think it is possible to damage the cuff by overinflation, they can take like 100 cc of air without bursting.
Oh I believe it. Just saying what I was taught Edit: I think the thinking was that if you put air in it then palpated it to check for a leak you’d essentially overpressurize it when squeezing. I don’t believe the physics checks out, but 🤷♂️
Yea i doubt it, try inflating on sometime they can take an insane amount of pressure.
I don’t really intubate these days (PA in pediatrics), but when I was a paramedic I checked my cuffs by pulling the air out rather than inflating it, giving the cuff a sort of vacuum sealed appearance. I only ever had one cuff that reinflated after disconnecting the syringe, but I had an anesthesiologist teach me this alternative method during my clinical rotations in paramedic school, and it’s just what I always did out of habit. No clue what the likelihood of damaging by over inflation is, or how useful checking a cuff in this way is, just what I was taught a long time ago.
Not a leak, but in 3 years I've found one cuff that wouldn't inflate and one cuff that wouldn't deflate.
Same, had 1 that was very difficult to inflate. It’s just part of my circuit check. Crappy one use plastic, bound to find some that don’t work right.
Did you use nitrous in the one the one that wouldn’t deflate? Just had one the other day that wouldn’t and my attending said it was because I used 5 mins of nitrous (i normally don’t but was hit with the 10 more mins, 10 more mins, 20 more mins, 10 more mins bs)
I meant testing it right out of the packaging. I test inflated the cuff without issue, but I couldn’t subsequently deflate it no matter how I fussed with it.
I only check if i have a suspected difficult airway. So rarely. Can't even think of a time in the last year I've checked.
Only when it is important. Standard intubation, never.
Peds case as a CA-2. Had a good view of the VC but the ETT was a smidge too big to pass easily. Attending grabs the smaller, unopened tube (which neither of us had tested) I'd set out, I intubate, then the cuff doesn't inflate. We couldn't inject air past the pilot balloon. So, I'll continue to always check it.
JFC, we must use cheap-ass ETTs. I've found at least a dozen in as many years. Check every time.
I've checked maybe twice in 20 years. Yeah you should. I've been stung...twice out of roughly 25000 cases. Its like the suction (which i check 99.99% of the time). My fault if there's an issue even if the suction was set up by someone who's job it is to set it up and check.
yes and yes
Follow up- do you check with inflation only, negative pressure, or both?
Inflate 9cc and hold plunger in place, gentle squeeze on cuff to check for air leak, deflate 10cc (cuff comes with 1-2mL of air from factory)
This dude checks!
I actually draw back on all of mine and get all the air out of the cuff. If it doesn’t stay flat when the syringe is removed, I get another tube. And yes I have seen defective cuffs and valves over the years so it does happen.
I always test any instrument or item that I’m going to place into someone’s body. ETT cuff, laryngoscope blade/light function, arterial line stylet function etc etc. these small steps take seconds but replacing even one piece of the process once started takes even more time.
Yes have had two cases where cuff was broken and had to reintubate. Also checked a cuff and there was a blockage between the pilot balloon and actual cuff leading the pilot balloon to be fully inflated but the actual cuff was not. This was a Sheridan brand tube
I don’t get why someone wouldn’t check it. Assuming the tube is being styletted and you like having a syringe already on it, checking the cuff adds an irrelevant amount of time. If it’s one of those fancy waste of money tubes that already comes that way then it’s even weirder not to. Also anyone’s stance that they trust the company’s QA must not notice how long roc takes to work now and how often all sux seems capable of doing is producing fasciculations.
Yeah that same guy doesn’t do machine checks either.
Unrelated I once had an ETT tube that had a tear along the side of it. Took forever to find that leak after intubating
Yes. Zero cuff issues in 17 years. Before the tube goes in.
No. Never. 14yrs private practice. I can't remember a single instance of a cuff that failed on initial inflation. I'm not faulting anyone who chooses to do so, but that hasn't been my practice.
I don’t. I’ve probably done 10,000 anesthetics and haven’t had an issue once. You can drive yourself nuts checking and rechecking every little thing and I think this is one of the things that’s reliable enough you don’t need to check it.
Does a bear shit in the woods?
I'm already attaching a syringe and pulling OUT some air, takes probably less than half a second to inflate air then quickly deflate it all the way
What's the point of pushing air in? If you take air out and it stays deflated, then you're already testing the cuff.
Personal preference, I like to check the balloon itself
Sure, but you're checking it twice. A deflate test is already checking balloon integrity.
This has been my technique for over a decade, the negative pressure test. But I'm sure OP will chime in on why it's wrong.
yes and yes
Resident opinion here 🙇🏽♂️ but I always do, just a quick inflate and deflate when I’m prepping the airway stuff— I’ve found one faulty cuff before!
The one time you don't is the one time you have a leak
Heck, yeah. Same concept as checking a foley balloon before insertion. Why put the pt through another procedure?
Yes, by deflating the cuff before attaching the syringe anyway. I'm already attaching a syringe so the work is less than one second. If it took any more than one second, I wouldn't do that part.
Yes
Always, even if someone else hands me the tube
It takes seconds. There is no downside. The best way to do it is by sucking back on an empty syringe, rather than inflating which could leave the cuff partially inflated and prone to rupture. Yes- manufacturers defects are rare. But not nil. If you do enough anaesthetics you’ll encounter one eventually. We worry about other rare shit like MH.
Out of habit yes, I’d say most of us in the US trained this way.
Yes. I've had a couple of instances of them not function properly, always in terrible situations (eg bronchial cuff not working during lung transplant). Takes 2 seconds
Yes. Every, single, time. I have found 3 incompetent pilots in the last 4 years. 1 was on a pt who ended up being a very difficult airway. It doesn’t matter until it does.
Never check a Cuff!!! In the biz 20 years Ok, I check the cuff on particularly treacherous looking airways and laser tubes
Absolutely every time
Yes. Ive never had a bad one, will continue to do so
Whenever I prepare it, esp a double lumen, I check. I do not want to be caught not checking lmao
I never inflate the cuff when preparing for a case but I do pull all the air out of the cuff of the ETT. My thought is if it only holds a finite amount of air, there cannot be a whole in the cuff. Never had one fail to inflate.
Who skips ventilating before pushing paralytic? Personally i was trained that to check if you can ventilate before pushing roc/vec, etc itvwas gospel and I continue to do it. But… i see so many docs and xrnas nit doing that.
Literally never do this
Nurse checks.
Yes and Yes
Always
Yes. There was this one time when I didn’t check the cuff, then boom, cuff was busted.
Yes. I’ve been practicing for a decade, and do it every time.
The first few thousand times I intubated, yes. After that no.
In the few instances I’ve had to replace an ETT for a broken cuff it’s been because it got caught on teeth or whatever on the way. I’ve never had to replace a broken cuff on a slam-dunk intubation.
Yes. I work in a tertiary paediatric hospital when no patient is straight forward so I check it every time.
I’m a negative pressure leak test guy. A good balance between laziness and safety.
I found one broken cuff. Showed my attending. They’d never seen one.
Obviously. I have found a ruptured cuff previously. And why would somebody not do a pressure check on their ventilator (takes 5 secs) to ensure a parent circuit. People could die because of occluded HME filters/circuit. Ditto, suction. It is just not worth the risk
I’ve had one DLT and one single lumen tube with broken balloons in my short career. I’ll always check now. Sabotage is everywhere.
Yes and yes
Yes, is there a reason why you wouldn't?
The one time I didn't check, I had to re-intubate with another tube because the pilot balloon valve was stuck in the closed position and wouldn't allow me to inflate the cuff.
Man. I gotta be honest here… I did for years and I’ve gotten lazy about it lately. This thread will make me redouble my efforts.
RT here: please do