What should a respiratory therapist do if the cuff pressure of a tracheostomy tube is measured at 5 cm H2O after inserting air?

• A. Add 15 mL additional air to the cuff
• B. Cut the pilot tube
• C. Replace the tracheostomy tube
• D. Record the pressure in the patient's medical record

Answer: (C)

The most suitable action when the cuff pressure of a tracheostomy tube measures as low as 5 cm H2O is to replace the tracheostomy tube. A cuff pressure this low may indicate that the cuff is not properly sealed, which could compromise the airway management and allow air to escape around the tube. This ineffective seal can lead to inadequate ventilation and increase the risk of aspiration or respiratory complications.

Replacing the tube ensures that the patient has a secure airway and that ventilation can be effectively managed. It may also prevent further complications related to inadequate cuff pressure, such as recurrent pneumonia or obstructive events.

While documenting the situation is essential for maintaining accurate medical records, it does not address the immediate concern of a low cuff pressure. Adjusting the cuff pressure directly by adding air could be a temporary measure, but if the cuff cannot maintain pressure effectively, the safest option is to replace the tracheostomy tube altogether. Cutting the pilot tube is not a viable or acceptable solution as it may lead to further complications and would not solve the issue at hand.