Endotracheal Tube Cuff Pressure Monitoring Utilizing Manometers

Abstract

Problem: Over-inflation of the endotracheal tube cuff has been linked to higher instances of post-operative sore throat in patients undergoing general endotracheal tube anesthesia. Purpose: The purpose of this quality improvement project is to implement manometer use among anesthesia providers at a community hospital in Maryland to maintain endotracheal tube cuff pressures between 20-30 cmH20 to reduce the incidence of postoperative sore throat. Methods: Education on the proper use of manometers and evidence-based practice recommendations was provided to the anesthesia providers via educational handouts. Education on evaluating post-operative sore throat was provided to the Post-Anesthesia Care Unit nurses using educational handouts. A Random Observational Tool was created to track cuff pressures and completed by the anesthesia providers. A Post-Operative Sore Throat assessment tool was used by the Post-Anesthesia Care Unit Nurses to assess and track post-operative sore throat rates. Manometers were placed in two operating rooms. The post anesthesia care unit charge nurse was notified of manometer room selection to follow up on post-operative sore throat assessments and completion of the data collection tool. Results: Out of the 60 observations obtained during a 10-week period, analysis showed that 80% of patients denied experiencing a post-operative sore throat when assessed in Post Anesthesia Care Unit. 100% of anesthesia providers used manometers to maintain cuff pressures within recommended ranges. Out of the 60 random observations, 19 cuff pressures were initially measured out of the recommended range of 20 to 30 cmH20 and were adjusted appropriately to the recommended range with a manometer by the provider. Conclusions: This site has a post-operative sore throat incidence of rate of 20% which is lower than what current literature cites (44%). At the conclusion of the project, cuff pressure monitoring improved (0% vs 66%). There was a positive trend with respect to the use of manometry and reduction in POST rates. Change champions within the anesthesia department and PACU staff were identified to maintain sustainability for the practice change.