Cuffing ET Tubes in cats? VN's opinions and experience

Re: Cuffing ET Tubes in cats? VN's opinions and experience

Selena Carnell — Mon, 29 Oct 2012 21:27:07 GMT

Never heard of any problems with cuffing in cats, in all my years in vn. Still use cuffed tube and and sensible with the amount we puff the cuff.

Re: Cuffing ET Tubes in cats? VN's opinions and experience

jules007 — Fri, 26 Oct 2012 16:14:32 GMT

we had a run of having some complications with our cat GA's - couldn't pinpoint anything specific but I decided to get in touch with Andrea Harvey who is a specialist in feline medicine. Amoung other things she recommened using uncuffed 5.0 or greater sized ET tubes and after speaking to the vets we initiated this protocol. When you are used to using 3.5cm cuffed tubes the 5.0 seem enourmous but once the technique is harnassed they are no problem to get down (they must use plenty of LA spray and ensure it is coming in to contact with the larynx!!). One of our vets choose to continue using the cuffed version- until she had a cat develop a tracheal tear and then she opted for the uncuffed.

The advantage of the uncuffed is that the risk of tracheal tear or necrosis is virtually nil, also because the lumen of the tube is so much greater there is also less risk of a blockage obstructing the airway. The disadvantage is that it can take people a while to become confident getting the 5.0 tube down and if the larynx isn't adequately anaesthetised they can have problems and end up going for a smaller tube where the gas can leak around.

Dentals are fine as long as the pharynx is well packed - haven;t had a problem here.

So far so good and I would definitetly advocate the uncuffed tube use especially as I have seen complications with the cuffed tubes - not many but enough for me to feel that the uncuffed are safer.

Hope this helps.

Re: Cuffing ET Tubes in cats? VN's opinions and experience

Aimee Barber — Fri, 26 Oct 2012 11:50:01 GMT

We always use cuffed tubes in cats, we also ventilate most things so it is a necessity. I dont like the red 'rubber' tubes and unfortunatly portex don't make small cuffed tubes but I have found some portex style ones in the JAK catalogue that are cuffed. they have a bigger diameter and a very small smooth cuff

when inflating im always very careful and make sure i inflate slowly and listen to any escape gases (on oxygen first obviously). then always triple check I have deflated before extubation. As long as the people using cuffed tubes are happy and confident they know what they are doing then there shouldnt be a problem.

Re: Cuffing ET Tubes in cats? VN's opinions and experience

Charmaloo88 — Fri, 26 Oct 2012 07:29:30 GMT

I lightly cuff stick and swab down there. In over 6 years never had a problem :)

Re: Cuffing ET Tubes in cats? VN's opinions and experience

emvn80 — Thu, 25 Oct 2012 20:53:38 GMT

In dentals I think packing the oropharynx with a swab or throat pack is probably safer than cuffing, this prevents the risk of aspiration without the risks of cuffing (see above)

Re: Cuffing ET Tubes in cats? VN's opinions and experience

emvn80 — Thu, 25 Oct 2012 20:51:01 GMT

***tracheal*** & **twisting**

Re: Cuffing ET Tubes in cats? VN's opinions and experience

Charmaloo88 — Thu, 25 Oct 2012 20:50:54 GMT

Almost always cuff for same reasons as above...especially if they're having dental work otherwise you're just asking for trouble!

Re: Cuffing ET Tubes in cats? VN's opinions and experience

emvn80 — Thu, 25 Oct 2012 20:49:45 GMT

I am very cautious about cuffing ETT's in cats due to the risk of traceal tears/ rupture and necrosis of which there have been quite a few reported cases of. I also use a tube with a cuff but don't inflate unless I need to. I always leak test and use the capnograph to check for leaks. If I do cuff I would use a 1 or 2 ml syringe and put only a small amount of air in. Most reported cases with problems have been dentals, possibly because people are over enthusiastic about cuff inflation in case of aspiration but also likely to due the constant teisting and torsing of the neck and head that goes on with dentals. Therefore I think it's crucial to disconnect from the breathing system when turning the cat over and being careful with pulling the head around, especially when the cuff is inflated. I have to say I rarely need to inflate the cuff in cats although I do sometimes if there's a significant leak. I always use the largest lumen ETT possible (without forcing) which is normally a 4.0-5.0 ETT, leak test and use the capnograph trace to check for leaks and in my opinion take care with twisting /turning the head and disconnect from circuit when turning . I think these are the important points. I am cautious about pollution, do anaesthetics all day every day ad am pregnant(!) so would not put myself at risk of pollution, but this works for me. Hope it helps :)

Re: Cuffing ET Tubes in cats? VN's opinions and experience

bongo — Thu, 25 Oct 2012 20:05:33 GMT

we don't use cuffed tubes incase there is a situation with fluid in the mouth/ larynx. We use uncuffed tubes other than that and use capnography. If there is a dodgy trace which suggests a leak we will re-intubate with a bigger tube

Re: Cuffing ET Tubes in cats? VN's opinions and experience

Celine — Thu, 25 Oct 2012 20:02:17 GMT

Blimey, I am out of touch, I have not really come across this concern despite locuming a lot for several years - but have been out of private practice for about 2 now...

Have always used cuffed tubes in cats for my 12 years of nursing and have never had a problem, (to my knowledge)

I now work in a zoo and we cuff tubes on every mammal species (but never in birds due to the complete cartilaginous rings in their trachea)

Re: Cuffing ET Tubes in cats? VN's opinions and experience

Paulette — Thu, 25 Oct 2012 17:53:08 GMT

Hello :)

Agree with Julie-Ann. The seal is to ensure there are no gaseous leaks, to protect staff and to ensure the patient is receiving all the fresh gas intended for that patient, not just for effective IPPV. I have done a lot of locuming and can't say I've come across any practices using cuffed tubes in cats at all, however we did at one of my training practices (obv they may have changed this by now). I don't see a problem with cuffed tubes in cats as long as the tube plus the cuff is not too big to intubate ie doesn't cause trauma on the way down as not completely smooth surface/forcing it and obv make sure fully deflated before extubation. I must say though I think a lot of practices now use larger uncuffed tubes in cats and check for leaks with oxygen (which you should with every patient before anaesthetic gas is switched on anyway), and re-intubate with a larger tube if necessary. I guess you could argue this could be more dangerous as diameter of ET is increasing and perhaps pressing on sides of trachea? Some vets I've worked with refuse to use cuffed tubes in cats. It's up to the vet in charge of the GA and your personal preference I guess :)

Re: Cuffing ET Tubes in cats? VN's opinions and experience

Cheryl RVN — Thu, 25 Oct 2012 17:38:34 GMT

Yes i agree with the technique and the worry with over inflation. It is interesting and reassuring to know that you do this on a daily basis and have no problems.Thanks xxx

Re: Cuffing ET Tubes in cats? VN's opinions and experience

Julie-Anne Wilson — Thu, 25 Oct 2012 17:21:28 GMT

I've always done it. If you don't cuff it, there's not a proper seal and also not a safe working environment as iso could be leaking out. The danger doesn't lie in a tube being cuffed, it lies in someone over inflating so if it's done properly there's no worry about it.