ET tube - page 2

hi i went help what is right way to fix ET tube ? Thank... Read More

  1. by   dawngloves
    At first, I was picturing a kid with a big X over it's mouth and I was wondering, "How do you mouth care???" LOL!
  2. by   dawngloves
    Quote from nell
    Wow, I wonder what the cost issues are with unplanned extubations? - collapsed alveoli, traumatic reintubations, what else?

    nell
    The same way it's been done for years. Vigilant nursing and a good taping technique.
  3. by   Gompers
    Quote from Mahema
    We still use tape, I think it's a cost issue for us. Do you like the neobar? How is it on the skin? How often do you need to replace it? Do you have many unplanned extubations with it's use?
    We still use tape as well. We put Duoderm on the cheeks and then use 1/2 inch white fabric tape in a moustache fashion, double layered. We have pretty few accidental extubations. Then again, we are all very anal and our "tape jobs" are usually pretty sturdy and neat. I see pictures of preemies on the internet with tape all over their faces - up the bridge of their nose, over their chins, even around their heads sometimes!

    I do wish we could try the Neobars, though. The one thing that causes us the most extubations is retaping. With the Neobars, it seems a lot more controlled! I'd also love to use them for the big PPHN kids who are on Pavulon and have gooey mouths. I got some samples from the company and brought them to work, but wasn't allowed to try them!
  4. by   justjenny
    We use Neobars and they are fantastic...but they do seem to have some "play" with the tube (ie: even with a secure tape job the tube can move slightly up or down because the plastic has a little bit of give to it)
    For all new babies and tiny ones the ET tubes are secured with a cord clamp, believe it or not. They drill a hole in the center of a closed cord clamp that fits the particular ET tube size...VERY SECURE!

    Jenny
  5. by   SteveNNP
    The x-shaped tube holders get locked in place with a plastic clip. ABSOLUTELY no play in the tube, unlike the neobars which allow the tube to slide when it gets slimy from spit....
  6. by   preemieRNkate
    Quote from justjenny
    We use Neobars and they are fantastic...but they do seem to have some "play" with the tube (ie: even with a secure tape job the tube can move slightly up or down because the plastic has a little bit of give to it)
    For all new babies and tiny ones the ET tubes are secured with a cord clamp, believe it or not. They drill a hole in the center of a closed cord clamp that fits the particular ET tube size...VERY SECURE!

    Jenny
    Ok, you have to tell us how you use cord clamps please!

    We use elastoplast tape, cut to fit the baby. First we put a duoderm moustache, then a Y (we put the tube on either side of the mouth, switching with retaping jobs), then an H. I don't feel that we have to many unplanned extubations, most of us are pretty anal about taping.
  7. by   justjenny
    Quote from preemieRNkate
    Ok, you have to tell us how you use cord clamps please!
    .
    I know sounds totally weird, right?!!?

    This is for tiny babies, obviously.
    Before intubation the clamp is slid onto the ET tube via the hole that was predrilled. (I believe, they are 99% intubated in the delivery room in these situations so I don't get to see it)
    the cord clamp is placed at the mouth/lip area (gosh this is harder to explain that I thought)
    tape is placed on the cheeks on both sides and the cheeks are "fishlipped". The tape is split in half at the ends and one end is wrapped around the cord clamp, the other half is wrapped around the ET tube and this is done on both sides. Our ET measurements are at the gumline, and you have to allow for .5 for the width of the clamp when measuring for placement.
    It almost looks as if the baby is biting down on the clamp (which of course they are not...it is not in between the gums) and the lips are on top and on the bottom (not trapped under the clamp)
    This is replaced with a neobar after a few days or so (some RNs would rather keep the clamp with certain babies because of the security)
    Drawback? Yea, oral care is either difficult or impossible (picture a 22-23 weeker...)
    Benefit? It is so secure because of the tape method, and because the size of the hole/size of the tube fit so well...there is no tape getting slimy and slippery from saliva...the tape is above the clamp(on the tube) and on both sides.

    HTH
    Jenny
  8. by   sofiam
    hi! its really hard to imagine! do you have any picture of that?
  9. by   twinkletoes53
    "Do you like the neobar? How is it on the skin? How often do you need to replace it? Do you have many unplanned extubations with it's use?[/quote]"

    We started using Neobrs in our NICU a couple of years ago. We use it only until a baby weighs 2.5 kg.;after that the Neobars are too small, and do not support the ETs well. We haven't had an increase in extubation with them. I find problems with taping an OGT or TPT with a Neobar in. We tape those to the upper lip, so you have to go under the Neobar a bit if it's in use. Some nurses tape the OGTs to the Neobar, with a different piece of tape. Follow the instructions that come with the Neobar. it makes a big difference in the number of extubations.
    I like it because it takes pressure off the top of the baby's mouth, and the ETT doesn't push against the baby's upper gums. When turing an intubated baby, I have a death grip on the ETT where it attaches to the bar! It does secure an ETT with less slack than regular tape.
    Extubations occur if the bar has come loose off the baby's chin, and was not replaced. Or if the baby slides down in bed---the ETT is pulled up and the baby may extubate.
    If used corretly, I really like using the Neobars.
  10. by   Gompers
    Quote from yappymutts
    We use it only until a baby weighs 2.5 kg.;after that the Neobars are too small, and do not support the ETs well.
    Oh shoot, really? The patient population I was more interested in using the Neobar with was the over 3kg crowd - mainly the PPHN babies on paralytics because their mouths are always so gooey that their tape gets gross and loose. When I got the sample pack I thought there were six sizes, and that the biggest one was for kids like 4kg or so...
  11. by   zeyn
    hi there;

    I'm happy to hear that we have same kind of problem and using same kind of thing. Actually we are using x shape with white fabric tape but it is hard to clean it. Cleaning is most traumatic than taping it. for cleaning we are using ether. It's kind of alcahol I know it is terrible but our white fabric tape can't get out with skin if we can't use it. We use what we have.
    Last months we met neobar. I'm proud of our chief because she is recommended it. I don't think neobar is using all over the world. After read your all posted, I understand that it is very famous and useable. I should try it.
    Maybe you realize that my english skill is poor. I'll take an english exam for academic eduation. I'll wait for support and recommendation.
    I'm happy to join here.
    junior nurse "z"
  12. by   twinkletoes53
    Quote from Gompers
    Oh shoot, really? The patient population I was more interested in using the Neobar with was the over 3kg crowd - mainly the PPHN babies on paralytics because their mouths are always so gooey that their tape gets gross and loose. When I got the sample pack I thought there were six sizes, and that the biggest one was for kids like 4kg or so...

    The largest size NeoBar, I think it's the peach one, says something like "for babies over 2200 grams" on it. We were using Neobars on all sizes of babies, but found that with the larger and more active babies, the Neobar would come off their cheeks more easily.
    We used to prep our baby's skin with benzoin, but do not use anything with the Neobars, just make sure the skin is dry. I wonder if that made a diference.
    We do not have a L and D at our hospital, and that may make a difference, too. All out babies are transported in, and their faces have already been "cleared" of birth matter. We will sometimes get transports of babies that are several months old and have never been home.
  13. by   Mimi2RN
    The largest size Neobar is blue, and they do fit bigger kids, even 8 pounders.
    We rarely use tape any more.

    http://www.neotechproducts.com/store...=NT-5&session=

    We use Cavilon (the lollipop kind) to prep the skin, especially on the vernix covered preemies.

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