Endotracheal tube securement - page 2

I am an RN who worked in an ICU a while ago, and there the standard for ET tube securement was adhesive cloth tape. I am now doing a research project and would like to find out how common it is for ICU's to use adhesive tape. Is... Read More

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    We actually did a trial and analyzed the pros and cons of 11 different ett tube holders our institution used utilizing set criteria. We now utilize (after trialing) the AnchorFast ett holder and it is great. We had a pt that due to her cond. required an ett for 20 days. No breakdown and had on the original holder!!! It was awesome. It stays clean and dry, easy to rotate and do oral care. Our self extubations are nil. RNs and RTs love it. Sorry if I sound like a rep or something, but it is a great product. Good luck!

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    We use adhesive cloth tape and it's unlikely we'll ever make the move to any manufactured tube securement device simply because 98% of our patients are nasally intubated. Our docs say that the devices aren't suitable for nasal tubes. I'm sure they're wrong about that, but I'm just a nurse. We have one kid who has been intubated continuously for nearly a year. (Parents refuse a trach.) Every so often s/he has a bronch and they change the tube for a larger one. Poor face is a mess from the frequent tape changes, but again, I'm just a nurse.

    findingmywayRN, the way our tapes are applied is pretty simple. The RTs do all the taping; they cut three pieces of tape (1/2 inch for infants, 1 inch for older kids) to a suitable length. Two pieces are then cut lengthwise for about three inches into two strips attached to the wider end of the tape. The first piece goes on the upper lip so that the bifurcation of the tape is at the spot where the tube emerges from the nose. The top strip continues across the face to almost the kid's ear. The bottom strip is wrapped snugly around the tube so that the edge of it is touching the nose. A narrow piece of this is folded back on itself to form a tab for future retaping. The second piece is applied in the same manner but starts from the opposite side of the face. The third piece of tape is then notched in the center so that there's room for the patient's nose; it goes on over top of both previous pieces of tape as an additional layer to protect the actual securing tapes. Sometimes this process is carried out once a shift, if the kid's got sinusitis (and don't they all?) or is sweating.

    Once in a while we'll get a transfer from another hospital or an admission brought in by EMS where an ETAD has been used. Well, the stretcher isn't even back in the ambulance before "that thing" is off and tape is on!
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    Quote from janfrn
    .............because 98% of our patients are nasally intubated..................

    ..............we have one kid who has been intubated continuously for nearly a year. (parents refuse a trach.)...........
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    yeah, what you said!!
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    Quote from findingmywayRN

    sicushells: Are the ties easy to work with? How quickly can the knots be removed (or do you cut them off?)
    We usually knot the tie around the ETT which usually needs to be cut off, (especially after a few days when saliva and mucus build up Bleh!), and then do a bow tie around the head, usually ending near one cheek, which is quick to undo. I think it's pretty easy because I'm used to it, and it's rare I have to deal with anything else.
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    I have to second the vote for the Hollister AnchorFast. We trailed several different kinds and this is by far the favorite. It is super easy to do oral care, prevents skin breakdown and does not need to be changed frequently. Our policy is to move the tube (right, left, midline) q2h when doing oral care and turning the patient. If we turn our patients q2h to prevent skin breakdown on the tush, why not move the tube to prevent breakdown of the lips? This is the only device that makes repositioning the tube easy and safe.
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    We are currently switching over to Hollister. I saw it at NTI and I hope it works as well as it I think. Along with ease in tube rotation, placement and oral care, it can stay on the face for up to 7 days. It adheres with a wafer like the stoma wafer. Can't say was thrilled with the Rep and the in-service. Here's hoping! Unfortunately, I don't think
    they have them for little people
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    We also use the E-TAD. It is easy to do mouthcare, move the tube, can still use the good bite blocks, and easy to put on. Doesn't get slimy, or leave rashes or cuts on face. CAT
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    In CVICU (post-open heart) I use tapes and change them qshift. I extubate most of my patients there within 24 hours, so it saves money. Plus the nurses are used to them and god forbid I use something newfangled contraption like an ETT holder... I'd never hear the end of it. They would totally freak out lol. Doing up the tapes takes 2 ppl. One to wrestle the tape and one to hold the tube. Once you get used to it- it's not difficult. Tapes get slimy sometimes though if you get a drooler- you might have to change them more frequently.

    Otherwise we use Hollisters or ETADs in SICU and MICU where pts are intubated longer- sometimes until they are trached. Gotta watch the top lip for breakdown. But usually it's not a problem as long as the vent tubing isnt weighing down the ETT holder.

    For pts that are pretty wild we have these really expensive holders that have built-in bite blocks and steel teeth clamps that dig into the side of the ETT. I forget who makes them- but they are no joke. You tape those things once and they're not moving anywhere. Great for weaning neuro pts that go on sedation vacation but can't yet protect their airway.

    Let me know if you have more Qs
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    Warning, a little off topic... This thread pops into my head every time I watch TV... and I'm sure you all know why! TV characters never have their ETTs secured at all. I was watching a soap today (I'm home sick, cut me some slack) and a character was brought into ER with a TBI caused by tornado debris. Her ETT was not secured with anything, then the "paramedic" bobbled the Laerdal, causing it to fall onto the stretcher, ETT and all. The actor just picked it up and slid the ETT back in, then recommenced bagging. Of course, she immediately went into V-fib and they shocked her through her clothes. I laughed so hard I had a coughing spell.

    It's not only the soaps though that lack realism. Even ER and Grey's Anatomy, with their oh-so-highly prized medical advisors, have those yeah-right moments. I watch out of morbid curiosity to see just what new twist they're going to put on things.

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