Endotracheal tube securement

Specialties MICU

Published

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 it still a common practice or is it more common to use an ET tube holder, or even some other method? Also, could you tell me what you find the pros and cons of your ET securement methods?

Thanks for whatever insight you can provide!

.............because 98% of our patients are nasally intubated..................

omf'ng!!!

..............we have one kid who has been intubated continuously for nearly a year. (parents refuse a trach.)...........

omf'ng!!!

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Specializes in NICU, PICU, PCVICU and peds oncology.

yeah, what you said!!

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Specializes in SICU, Peds CVICU.

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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Specializes in CCU.

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:confused:

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Specializes in critical care.

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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Specializes in NICU, PICU, PCVICU and peds oncology.

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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Specializes in PICU.

Our PICU uses tape, only tape. It holds very securely. We retape prn, which is much more often on kids with a lot of secretions, of course. We will often ask for a bolus of sedation or paralytic before retaping. I would say our accidental extubation events are few and far between, thankfully.

I do transport between facilities and I don't recall seeing a pediatric facility that uses tube holder devices. I'm curious, I wonder how well they work on kids.

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Specializes in Peds.

I worked in a unit that used them for bigger kids. They worked very well. I remember on kid, an adolescent with Down Syndrome who was admitted in septic shock. Very ill on admission and several days before he started turning around. When he did, well I think we all know how kids with Down's are when they start feeling better. We needed to keep the ETT in and in the end he had an ETAD across his cheeks holding the ETT and another one on his forehead securing the circuit so he could toss his head to his heart's content. He looked quite odd, but it worked.

We did have a lot of trouble with the NeoBar. The sections where the ends of the bar were laminated between the Duoderm and the outer covering would delaminate and the tube would just slide out.

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In our unit we typically use cloth tape, as this kind of tape is the most "sticky." We start with the tape around the back of the head, bring it above the ears (so the tape doesn't slip down), bring tape from one side of the head, wrap around the tube, and end by securing to opposite cheek then repeat with the tape from the other side. We change tapes daily and move the ETT to the opposite side of the mouth when we change them to prevent skin breakdown. Occassionally we will see a securing device, but these are not preferred because they are so bulky (difficult to maneuver around with mouth care and shaving), wrap around the head UNDER the ears, and often slip down.

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Tube Tamer

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