CLINICAL PRACTICE GUIDELINE 39 atelectasis or has evidence of aspiration/laryngeal penetration (Cuff Deflation Discontinuation Policy). Reasons for discontinuing or reducing the length of time are to be documented in the progress notes and the physician is to be notified. X. Hold all cuff deflations if the patient complains of nausea or is vomiting. B. The Jackson Trach can be 1–2 sizes smaller than the existing plastic trach, after discussing with the physician. C. RCPs can cap trachs and titrate O2 to >92% via TTO on weaning patients, if Jackson Trach is a size 6 or smaller. D. See policy and procedure manual for TTO per hospital and aerosol procedures. XI. Changing to a Jackson Trach: A. RCPs can change the patient to a Jackson Trach upon physician’s order after the cuff has been continuously deflated for 48 hours and there is no sign of distress.