Disposable ETT cuff manometer

[TransportJockey]

Looking for a small disposable manometer to keep in my work bag. The AG Cuffil looks good but I can't find pricing info or a purchase point. I do enough tubes the last two years that I'm interested in finding one. Plus I know my service looks at it as an unneeded expense

 

[PotatoMedic]

A vet supply store listed them as 25 pounds, unknown if that is each or for a box of 10. So looking at 50 dollars roughly.

 

[PotatoMedic]

https://www.medida-shop.de/shop/de/...ntubation/9421/ag-cuffill-cuffdruckmessgeraet

If you feel like ordering in German.

 

[ThadeusJ]

Here's one a little closer to home: http://www.kalmed.net/PylantMonitor/Literature/tabid/154/Default.aspx

 

[ISRDEU]

Hi there,

Try search of CUFFILL

 

[TXmed]

AG cufill

 

[TransportJockey]

Hi there,

Try search of CUFFILL

Hi there. You're an idiot if uou think I haven't tried that already

 

[TransportJockey]

Here's one a little closer to home: http://www.kalmed.net/PylantMonitor/Literature/tabid/154/Default.aspx

I actually just got a email from them and it's not fda cleared yet for use in the US

 

[TransportJockey]

AG cufill

That looks like the best option. I contacted the distributor to find an option for getting one or two. If the price is low enough maybe I can convince my bosses to get therm.
Boundtree is asking 1k/bx though

 

[CANMAN]

Why do you want disposable? Just for size?

 

[TransportJockey]

Why do you want disposable? Just for size?

And price. Those are 350 each

 

[DrParasite]

If your service isn't providing them, and most places don't use them (for whatever reason), why do you want one?

 

[DesertMedic66]

If your service isn't providing them, and most places don't use them (for whatever reason), why do you want one?

For the benefit of the patient? My service doesn’t supply coban or actual good quality chest seals. I supply both items because they will help me do my job and will benefit the patient.

 

[DrParasite]

For the benefit of the patient? My service doesn’t supply coban or actual good quality chest seals. I supply both items because they will help me do my job and will benefit the patient.

So when your patient goes south, and the lawsuits get filed, and the investigation reveals that you are using equipment that is not supplied by your agency, you do realize that your agency (or more likely, their insurance company) is likely to place all the blame on you (regardless of the fact that the reason the patient died had nothing to do with your personal supplies), because you were using unapproved and unauthorized equipment?

If your medical director hasn't authorized its use on the ambulance (because if he or she had, it would be on the ambulance, so by default, all non-provided medications and equipment is not approved, unless explicitly stated otherwise), why are you using unauthorized equipment? Couldn't it be interpreted as working outside your proved scope of practice?

I mean, using your logic, I could bring my personal set of irons (flat headed ax and haligan married together), because I might need to force a door to get to my patient to gain access to my elderly patient who fell (which leads to better patient care) or I can work on gaining access to an MVA before the FD arrives (again, quicker access leads to better patient care). Now if your agency provided you that equipment on to keep on the ambulance, that's a much different story.....

 

[ThadeusJ]

A quick literature search revealed these studies for those who may have access to them. You can get complications in as little as a few hours, leading to rupture into the esophagus.

 

[Tigger]

So when your patient goes south, and the lawsuits get filed, and the investigation reveals that you are using equipment that is not supplied by your agency, you do realize that your agency (or more likely, their insurance company) is likely to place all the blame on you (regardless of the fact that the reason the patient died had nothing to do with your personal supplies), because you were using unapproved and unauthorized equipment?

If your medical director hasn't authorized its use on the ambulance (because if he or she had, it would be on the ambulance, so by default, all non-provided medications and equipment is not approved, unless explicitly stated otherwise), why are you using unauthorized equipment? Couldn't it be interpreted as working outside your proved scope of practice?

I mean, using your logic, I could bring my personal set of irons (flat headed ax and haligan married together), because I might need to force a door to get to my patient to gain access to my elderly patient who fell (which leads to better patient care) or I can work on gaining access to an MVA before the FD arrives (again, quicker access leads to better patient care). Now if your agency provided you that equipment on to keep on the ambulance, that's a much different story.....

Classic EMS doomsday lines. Do you have any proof of this ever happening? Any examples? Maybe some relevant case law?

I'm sure not using an agency supplied stethoscope opens me up to incredible liability. I mean it's not like my agency approved it, how do they know I can even hear lung sounds??

 

[DesertMedic66]

Classic EMS doomsday lines. Do you have any proof of this ever happening? Any examples? Maybe some relevant case law?

I'm sure not using an agency supplied stethoscope opens me up to incredible liability. I mean it's not like my agency approve it, how do they know I can even hear lung sounds??

I typed up a response but this one is much more nice haha.
Not all of our stuff is agency approved. Our medical director doesn’t say “you must have this type of EKG patches from this company”. Our company just gets the best deal they kind find from our supplier that the crews don’t complain about.

I know some medics carry around cartoon bandaids for pediatric patients without any issue. The majority of people use their own stethoscope and more people are starting to carry the raptor shears.

Heck, I’m one of the few racetrack certified medics we have and our medical director doesn’t know how to use some of the special equipment that we carry. The supervisors have literally said “if there is any piece of equipment that will help you do your job at the track just let me know and we will get it”.

I know there are many cops and firefighters who carry small pieces of personal gear that they prefer to use. I’m not talking about bringing in my own LP15 to work.

 

[Peak]

@Remi would probably be able to answer this, but is there really a big difference between using a specific cuff pressure compared to slowly inflating the cuff until you no longer have air leak and stopping right there? I have never personally seen a manometer used to measure cuff pressures in the ED, PICU, ICUs, or ORs.

 

[VFlutter]

We just did some education on this so I am assuming we will be getting them at some point.

Our RTs checked cuff pressures once a shift in the ICU

 

[Carlos Danger]

@Remi would probably be able to answer this, but is there really a big difference between using a specific cuff pressure compared to slowly inflating the cuff until you no longer have air leak and stopping right there? I have never personally seen a manometer used to measure cuff pressures in the ED, PICU, ICUs, or ORs.

The modern high volume / low pressure ETT cuffs are designed such that if the tube is properly sized and the cuff is not overfilled, cuff pressures above about 20 are unlikely.

The problems with picking an arbitrary number (24 has always been common) and using a cuff manometer to inflate to that number are that, 1) you might not need that much pressure, which means that while your cuff pressure is probably still safe, it may still be higher than it needs to be and 2) it may not be enough pressure, and an inadequately sealed tracheal cuff can cause more pressing concerns than tracheal ischemia.

So yeah, I would agree that the minimal-occlusion pressure method (inflating until the leak is gone) is probably the best technique, especially with a hi-lo cuff on a property sized tube. The cuff pressure probably should be checked at some point but I wouldn't worry about it in the prehospital phase at all.