CLINICAL PRACTICE GUIDELINE 41 Appendix G: High Cuff Pressures Protocol The following protocol is a policy/procedure used by Craig Hospital, Englewood, Colorado (November 1996). Rationale: To establish guidelines to be followed for high cuff pressures. II. Add or subtract dressings under the flange on the trach tube to change the position of the cuff in the trachea. III. Try using a minimal leak if tolerated by the patient. Note: Aspiration may occur. With Physician Order I. If possible, insert a larger size tracheostomy tube. Use bronch with E-T tube to position the E-T tube in the trachea and measure for special size or design trach. Scope: Respiratory therapists. Policy Statement: Protocol for use if the patient’s cuff requires greater than 40 H2O cm to achieve complete occlusion of the trachea (no air leak). Procedure: I. Chest x-ray—check for deformed cuff. II. Bivona or special order trach of special size or design.