Endotracheal tube securement

  1. 0 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!
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  3. Visit  findingmywayRN profile page

    About findingmywayRN

    From 'In the future'; Joined Jan '04; Posts: 116; Likes: 19.

    23 Comments so far...

  4. Visit  flightnurse2b profile page
    0
    i've always used an ET tube stabilizer (the one with the Z shape in the middle, has a little bit of adhesive on the back), on an ambulance and in the ED. much easier than tape, and is better in preventing accidental extubation.
  5. Visit  LaurynRN profile page
    0
    We use tape and have found that most stablizers don't allow for aggressive mouth care. I would love to see some that do.
  6. Visit  Pedi-Gree profile page
    0
    Our ICUs use tape. Just tape.
  7. Visit  bethem profile page
    0
    We use cloth tapes tied in a particular way. There is some movement to get the EndoTrachead Attachment Device (ETAD) in our ICU which is an adhesive thing - like Comfeel with a zip tie on it.
  8. Visit  joeyzstj profile page
    0
    Tape is fine in a sedated patient, however you dont want to use it in a patient who is awake in my opinion. You can make a take wrap that goes around the back of their head, however when secretions get on this it often fails to hold the tube after a few days. Tape also allows the tube to move in and out more then a tube tamer doesn
  9. Visit  sicushells profile page
    0
    I work in the sicu, and most often we use ties. Knotted a few times around the tube and then once around the back of the head. We tie a knot near the cheek on one side and put 2x2s near the corner of the mouth to prevent skin breakdown. For patients with neuro injuries (they board down to us sometimes) we use adh. tape.
  10. Visit  findingmywayRN profile page
    0
    Thanks to everyone for all your responses! It's interesting to see the different things being done with ET tubes.

    For everyone who uses tape:
    Could you please tell me how often it is being re-wrapped on each patient?
    Also, what do you think is the best and worst thing about taping the ET tube?

    For those who use devices:
    How often are they changed? Any idea how expensive they are?

    sicushells: Are the ties easy to work with? How quickly can the knots be removed (or do you cut them off?)

    joeyzstj: how do you secure the tube when the patient is awake?
  11. Visit  joeyzstj profile page
    1
    Quote from findingmywayRN
    Thanks to everyone for all your responses! It's interesting to see the different things being done with ET tubes.

    For everyone who uses tape:
    Could you please tell me how often it is being re-wrapped on each patient?
    Also, what do you think is the best and worst thing about taping the ET tube?

    For those who use devices:
    How often are they changed? Any idea how expensive they are?

    sicushells: Are the ties easy to work with? How quickly can the knots be removed (or do you cut them off?)

    joeyzstj: how do you secure the tube when the patient is awake?

    When a patient is awake we use the tube tamer which is a device that is made specificially for ET tubes for long duration or awake patients. IT has a huge adhesive section that sticks to their cheeks on each side, a track that allows a clip to move the tube from one side of the face to the other if needed and it has a piece of adhesive plastic that wraps around the tube and then claps closed to the tube doesnt slip. Tape is great for surgery where the patient is sedated or for short term ventilation where the paient is sleepy and you are going to extubate when they wake up. We use the actual tamer device until it gets to where its not stick anymore and then we change it or if it looks nasty, we change it. So,basically we change it every three days or so. In my opinion you would need to change out tape more often then that. People very rarely tape and ET tube correctly anyways. The RT's, probably the older ones are the ones you should have show you how.
    Longie likes this.
  12. Visit  PageRespiratory! profile page
    1
    Quote from joeyzstj
    When a patient is awake we use the tube tamer which is a device that is made specificially for ET tubes for long duration or awake patients. IT has a huge adhesive section that sticks to their cheeks on each side, a track that allows a clip to move the tube from one side of the face to the other if needed and it has a piece of adhesive plastic that wraps around the tube and then claps closed to the tube doesnt slip. Tape is great for surgery where the patient is sedated or for short term ventilation where the paient is sleepy and you are going to extubate when they wake up. We use the actual tamer device until it gets to where its not stick anymore and then we change it or if it looks nasty, we change it. So,basically we change it every three days or so. In my opinion you would need to change out tape more often then that. People very rarely tape and ET tube correctly anyways. The RT's, probably the older ones are the ones you should have show you how.
    >
    The tube tamer is by far the best device I've seen for holding the ETT. It allows you to move it to avoid breakdown without disconnecting anything. The process for removing the tape without extubating the Pt was risky at best with 2 people. And after a few changes the glue residue will build up on the tube itself.
    Longie likes this.
  13. Visit  yeSICU profile page
    0
    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!
  14. Visit  NotReady4PrimeTime profile page
    0
    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!
  15. Visit  PageRespiratory! profile page
    0
    Quote from janfrn
    .............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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