Investigating the effect of an intervention on tracheal cuff pressure monitoring in the critical care environment of an academic hospital in Gauteng

Abstract

Tracheal cuff pressure monitoring plays a significant role in the care of patients in the critical care environment. Most patients in critical care environment are intubated with cuffed tubes via the ore or the naso-tracheal route, or a tracheostomy is performed. The purpose of the tracheal cuff is to maintain a seal between the tube and the tracheal wall, to prevent volume loss and ensure effective mechanical ventilation. Nurse practitioners in the critical care environment play a vital role in monitoring tracheal cuff pressure, which is often neglected in clinical practice. Purpose: To investigate the effect of an intervention on tracheal cuff pressure monitoring in the critical care environment of an academic hospital in Gauteng. Design and methods: A quantitative prospective non-experimental comparative design, with a collaborative qualitative method. The study had a pre and post intervention phase to compare the effect on an intervention. Findings: The study findings during the pre-intervention phase revealed inconsistency in the monitoring, night time monitoring poor and the found and the adjusted pressure documentation poor. Most pressures found to be non-compliant and serious non-compliant. The post-intervention results revealed an improvement in the night monitoring, but pressures were still found to be high. The consistency in the frequency of monitoring remains poor. Recording of the found and adjusted pressure had a small improvement. Conclusion: Inconsistent cuff pressure monitoring is done in the critical care environment. Comparing the continuous pressure monitoring, it shows that the frequency of monitoring need to be re-looked. Continuous in-service training may have an effect on the practice and the use of reminders can have an impact in the practice. Frequent clinical audits need to be conducted in order to evaluate practice and have plans for improvement. Clinical relevance: If the practice of tracheal cuff pressure monitoring can be done according to the revised guidelines, there might be an improved outcome of patients in the critical care environment and reduced costs.