Securing ET tubes

  1. Hello everyone,
    I would like to gather everyone's thoughts regarding the BEST way to secure endotracheal tubes. Until recently, the standard method for securing ETT's in my facility has been good old cloth tape.
    A few months ago, we began trialing Hollister Endotracheal Tube Attachment Devices (ETAD). For those of you who are unfamiliar with these, try to imagine: They consist of an adhesive "duoderm-like" facepiece that sticks to the patients upper lip and extends to the cheeks. There is a cloth strap that extends around the back of the neck for added support. The ET tube itself is held in place, also with an adhesive holder which is connected to the facepiece by a "track" which allows the tube to be easily repostitioned as often as needed. (Go to: http://www.hollister.com/us/products...=13&series=141 for a link). The major selling point for this device is reduced oral skin breakdown (because the tube can be easily repositioned).
    My experience with the ETAD has included an INCREASED incidence of lip breakdown, the device tends to slip if the patient is sweaty, difficulty changing from one ETAD to another, and the general thought that these deviced probably cost an arm and a leg.
    So my question is this: In your facility, what is the preferred method of securing ET tubes? What do you think (or know) are the benefits (or drawbacks) of the various methods?
    The way I see it: Tape is cheap, easy to change, and I personally have not seen any incidences of skin breakdown beyond a very few incidences of tape burn.
    Any input on this subject is greatly appreciated.
    Thanks in advance!
    •  
  2. 14 Comments

  3. by   SICUNIP
    we use the cloth tape method. I haven't seen breakdown from the tape. but have seen it from not moving the ETT from side to side when changing tape (breakdown on the lip) and even that is rare on our unit. Have seen big time breakdown from outside hospitals/ emts that use twill to secure the tape, seems to occur in a short period of time. the patients have large lines across their face from the twill. i've only used the commerically prepared ETT holders a few times, when patients come from outside hospital and we change it to tape when we admit them.
  4. by   hoolahan
    Originally posted by SICUNIP
    we use the cloth tape method. I haven't seen breakdown from the tape. but have seen it from not moving the ETT from side to side when changing tape (breakdown on the lip) and even that is rare on our unit. Have seen big time breakdown from outside hospitals/ emts that use twill to secure the tape, seems to occur in a short period of time. the patients have large lines across their face from the twill. i've only used the commerically prepared ETT holders a few times, when patients come from outside hospital and we change it to tape when we admit them.

    Ditto.

    I've been out of the hospitals and in home health now, but worked ICU's for years. I have not used the device you linked to, but an even worse contraption with a plastic device the ETT clicked into. We also noticed more breakdown on the lips with those devices.

    We had very few problems with the tape, and our RRT's were very aggressive with changing tapes as were the nurses. The only times we ever had problems were if the pt was extremely difficult to intubate and the risk of extubation, due to restlessness, for example outweighed the risk for a mouth lesion.
  5. by   RNforLongTime
    We use the cloth tape method in my facility as well! I HATE those plastic things that the ETT clicks into. Can't do good mouth care with those.
  6. by   TraumaNurse
    I have seen plenty of breakdown with the ETADs. Our facility uses ETADs and another funky looking holder that has a full head gear and foam pads on the cheeks. I do not like either one! I prefer good old cloth tape with frequent tape changes and tube repositioning. The hospital is always trying to find ways to save money...this is one I have suggested several times, but no takers yet! I agree with nurse-lou, with some of those tube holders, you can hardly get into the patients mouth for good oral care. My vote is in for good old tape!
  7. by   altomga
    Originally posted by SICUNIP
    we use the cloth tape method. I haven't seen breakdown from the tape. but have seen it from not moving the ETT from side to side when changing tape (breakdown on the lip) and even that is rare on our unit. Have seen big time breakdown from outside hospitals/ emts that use twill to secure the tape, seems to occur in a short period of time. the patients have large lines across their face from the twill. i've only used the commerically prepared ETT holders a few times, when patients come from outside hospital and we change it to tape when we admit them.
    same here!
  8. by   nowplayingEDRN
    Same methode...different state and facility.....cloth tape (when we have vents) although we do have a securing device but different from the hollister one.
  9. by   helix
    We have tried both devices mentioned, and the nurses hated them both. The cloth tapes works just fine, and I always say, if it ain't broken, don't fix it!!



    Helix
  10. by   conklip
    We are using that new holder. Have had much problems with them. the manufactor says that you need to reposition the tube every 2 hours.
    How often do you reposition the ETT???
    Would love to hear from as many as posible!!!!
  11. by   RNMBA
    Good "old-fashioned" cloth tape is used at my hospital.

    I've seen a lot of different methods and devices and none of them are any better or cheaper.
  12. by   conklip
    How often do you reposition you ETT's?????
  13. by   Jill - Pa
    From what I remember, the new ACLS guidelines are now saying to not use the "informal" tape method, but recommend the commerial-type secures.

    Our unit uses the type mentioned in the first post. When we tape-secured ETTs, we repositioned every 24 hours.

    Jill (Pa)
  14. by   RNMBA
    Our policy calls for repositioning every 24 hours. I use a towel under the circuit to decrease pressure on the lip.

    I quickly looked through the ACLS manual and I found the reference to commercial-type tube devices but I couldn't find a reference to why they were preferred. Anyone got a reference to a study?

close