Institutional Factors Affecting Practices of Endotracheal Tube Cuff Pressure Management at a Level 6 Hospital in Nairobi, Kenya
Abstract
Background: Maintaining endotracheal tube (ETT) cuff pressure within the therapeutic range of 20–30 cm H?O is essential for airway patency, effective positive-pressure ventilation, and prevention of tracheal ischemia or aspiration. Despite clear international guidelines, critical care nurses frequently encounter barriers rooted in institutional factors.
Broad Objective: This study sought to establish institutional factors affecting practices of endotracheal tube cuff pressure management at a level 6 Hospital, Nairobi, Kenya
Methodology: A cross-sectional quantitative study was conducted in June 2023. A sample of 85 nurses was calculated using Fisher’s formula and selected by convenience sampling. Data were collected using a self-administered structured questionnaire and an observational checklist. Analysis was performed with SPSS version 26.0 using descriptive, bivariate (?²/Fisher’s exact), and binary logistic regression statistics.
Results: The response rate was 100% (n = 85). Most nurses (90.6%) reported a nurse–patient ratio of 1:2. Only 7.1% stated that the hospital provides a manometer, while 50.6% reported that it does not and 42.4% were unsure. Guidelines/protocols were reported as present by only 21.2%; 54.1% were unsure. Manual palpation of the pilot balloon was available to 87.1% and preferred by 71.8% of nurses. Observational findings confirmed the complete absence of manometers, guidelines, and documented cuff pressures. Education level (p < 0.001), existence of protocols (p = 0.003), and confidence in ETT care (p < 0.001) were significantly associated with satisfactory practice. Overall, 52% of nurses demonstrated satisfactory practice. Confidence in ETT care (OR 3.51, 95% CI 1.04–11.85) remained an independent predictor in logistic regression.
Discussion: The findings point to significant structural deficiencies. A critical resource deficiency was noted.
Conclusion: The hospital lacked formalized policies and essential monitoring equipment (manometer), coupled with the high reported workloads. Therefore, this Level 6 hospital must not only provide continuous learning opportunities for ETT care but must also formalize evidence-based guidelines and provide the necessary resources to standardize this critical practice and guide safe culture transmission.
Keywords: Endotracheal Tube Cuff Pressure, Institutional Factors, Manometer, Guidelines and Protocols, Critical Care, Kenyatta National Hospital, Nurse-Patient Ratio, Pilot Balloon Palpation
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