Repairing Endotracheal Tube Cuffs

Occlusive cuffs on endotracheal tubes (ETTs) allow us to “protect the airway.” Air/fluid is added and removed from this cuff through a pilot balloon (blue in the image below) which is connected to the cuff on the distal segment of an ETT via a thin, plastic tube. Several times during fellowship, I’ve been called to the bedside due to inadvertent injury to this tubing. When this closed system is opened, the cuff can no longer be inflated. The airway becomes insecure due to an air leak which can also cause inadequate ventilation.

So what’s the big deal Rishi? Just exchange the tube using a Cook catheter!

Well, this isn’t always feasible. What if the patient is rapidly desaturating and has a known difficult airway… and your advanced airway equipment is nowhere to be found! What if the patient has a “fresh” tracheostomy where removing the trach tube can result in significant airway bleeding? Let’s try to temporize the situation!

Find out if your department (and especially the respiratory therapists) carry pilot balloon repair kits. If they don’t, you can “MacGyver” one with a blunt tip attached to a three-way stopcock and a syringe to inflate/remove air.

Repair kits come with everything you need! All you have to do is guide the metallic interface into the lumen of the old plastic tubing about a centimeter. Then use the new pilot balloon just like you normally would. You’ll want everyone to know that this is a TEMPORARY pilot balloon until a more permanent fix can be performed.

Drop me a comment below with questions! 🙂

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  1. Hay Dr Rishi,
    Could you please provide me with sufficient information about endotrecheal tube (and particularly its cuff). Information about properties of its material , how someone can made it , what is requirements in marking it, etc.
    Imagine a student wants to prepare and build an endotreacheal tube and it’s cuff in laboratory , and she needs to buy some materials and do test ,etc. please share with me any information. Thank you 🙏🏻 😊

  2. Hello dr.rish any different size this endotracheal tube and for emergency any other kind or all same.?
    In preperation what do u do for this. How much cc syringe need to insert for this tube.
    Thank you hope got your help to know all about this.’coz I handle tracheostomy patient.

    Be blessed,


    • There are different sizes/lengths of endotracheal tubes based on the size/height of the patient. Insert enough air to keep tracheal occlusion pressures as low as possible to maintain a good seal. This is usually around 20 cm H2O worth of pressure within the cuff measured by a Poser manometer.


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