Implementation of Endotracheal Tube Cuff Manometry in the Operating Room: A Quality Improvement Project

Background & Review of Literature: An endotracheal tube (ETT) is a device utilized during general anesthesia to secure the airway, providing a means for mechanical ventilation. The ETT features an inflatable cuff that ensures a tracheal seal and prevents complications. Cuff inflation pressure is monitored by manual palpation or a manometer. The AG Cuffill syringe is a manometer device used to measure ETT cuff pressure. The recommended ETT cuff pressure is 20 to 30 cmH2O. Deviations from the recommended range can lead to complications, escalating hospital costs, and compromising patient outcomes. Washington University School of Medicine’s (WUSM) Department of Anesthesiology lacks manometer standardization and protocols. Purpose: Implement a quality improvement project to increase the percentage of anesthesia providers utilizing the AG Cuffill syringe to monitor cuff inflation pressure and document the appropriate ETT cuff pressures in Barnes Jewish Hospital (BJH) operating rooms (ORs). Methods: The team assessed baseline data reports on ETT cuff pressures documented in the electronic health record (EHR). Comprehensive education in-services and visual cognitive aids were provided to anesthesia personnel. Following the educational training and implementation of visual cognitive aids, the proportion of documented ETT cuff pressures in the EHR was recorded. Implementation Plan/Procedure: The quality improvement initiative consisted of pre-intervention, implementation/intervention, and post-intervention phases. Educational in-service training happened twice a week for two hours each day for two weeks. The educational in-services were designed to enhance provider understanding, proficiency, and documentation in the utilization of AG Cuffill syringe manometers. Implications/Conclusion: The implementation of educational in-services and a visual cognitive aid promoting the AG Cuffill syringe manometer led to a 33% increase in documenting ETT cuff pressures within the recommended range in the EHR. There was also an increase in provider knowledge and attitudes attributed to the educational efforts. This project’s success highlights the potential for continued education to improve patient outcomes and supports a department-wide practice change within Washington University Department of Anesthesiology.