Severed cuff inflation tubing of endotracheal tube: A novel way to prevent cuff deflation

Abstract

A well-secured endotracheal tube (ETT) is essential for safe anesthesia. The ETT has to be fixed with the adhesive plasters or with tie along with adhesive plasters appropriately. It is specially required in patients having beard, in intensive care unit (ICU) patients or in oral surgeries. If re-adjustment of the ETT is necessary, we should be cautious while removal of the plasters and tie, as there may be damage to the cuff inflation system. This can be a rare cause of ETT cuff leak, thus making maintenance of adequate ventilation difficult and requiring re-intubation. In a difficult airway scenario, it can be extremely challenging to re-intubate again. We report an incidence where the ETT cuff tubing was severed while attempting to re-adjust and re-fix the ETT and the patient required re-intubation. Retrospectively, we thought of and describe a safe, reliable and novel technique to prevent cuff deflation of the severed inflation tube. The technique can also be used to monitor cuff pressure in such scenarios.

Management of endotracheal tube air leak—a simple yet an effective manoeuver

“…A modification of this technique with the addition of a triple stopcock valve in place of the pilot balloon has also been used. 3 Another approach by Sprung et al uses the inflation line of unused ETT and its connection to the severed inflation line of the patient's ETT via the use of a hypodermic needle. 4 In emergency, we used the technique used by Watson and Harris.…”

Options for Intraoperative Repair of a Cut Pilot Balloon on the Endotracheal Tube

“…A final technique described by Rao et al is to insert the cut end of the pilot balloon tubing into the locking adaptor from an epidural connecter and then connecting it to a three-way stopcock. 18 It should be noted that ETT cuff rupture or dysfunction can also occur independently of pilot balloon incompetency due to cuff trauma from direct laryngoscope, product defects, or changes in patient positioning. 19 In the event of cuff rupture, temporary measures such as continuous insufflation of the ETT cuff with air, cuff inflation with a viscous liquid such as normal saline or lidocaine jelly have been described.…”

Unforeseen complications: towel clip-induced pilot balloon injury resulting in endotracheal tube cuff leak during surgery

“…This enables reinflation using a syringe, while a stopcock establishes a seal to prevent deflation. Another technique, as described by Rao et al, entails inserting the severed tubing end into the locking adaptor of the epidural connector and a three-way stopcock [ 3 ]. Temporary measures, such as inflating the cuff with a viscous substance like lidocaine jelly, have also been outlined [ 4 ].…”