Accidental Extubation

danissa, LPN, LVN · Sep 5, 2008

Scary thought, isn't it! Has happened to us all, I would guess, some of these wee guys are Soooo determined that that pesky tube will come oUT! If this happens, yes, I would suggest taking that ET tube away .... Pronto....,you cant sucessfully inflate that babies lungs with a misplaced tube. Shout out for help, make certain you get it, and get someone to fast page the Docs. Just maintain that airway, thats your first priority.

Always remember ABC...airway first and foremost.!

Stuff like this happens with these wee ones, I'm sure you will deal with situations and learn from them as they arise. Each day brings a different challenge, but what else would we do in our worktime??????:chuckle

Best of luck to ya!:heartbeat

Finallyat40 · Sep 6, 2008

Happens to everyone, some more than others! Just keep your ABC's in mind, get the tube out and off the face, make a good seal and bag the baby up, while at the same time letting someone know you need a provider and an RT. Maintain your airway and you'll be fine. It's scary as all get out the first time, then you learn to just roll with the punches. I am currently orienting a new RN and I keep telling her to remember that these guys didn't read the book so we can't expect them to go by it!

Just an aside....we used to have a guy who did our head sono's that we nicknamed "the extubator"....He had the worst luck, and I honestly don't think it was ever his fault...he now works for the company that makes the sono machines and every once in a while we'll see him come through, but he's always called the same thing!

Good Luck to you!

Jamie

UTVOL3 · Sep 6, 2008

Just remember that even if it seems like an eternity to you while you remove the tape and old tube, grab your ambu and adjust your pressure and all that, it really isn't that long. I can see how people would get excited and accidentaly booger a kids face up trying to remove the tape, but, I had a preceptor who liked to kindly remind us how awful a skin tear on the face looks, especially if the kids in the funeral home...

Pedi-Gree, BSN, RN · Sep 6, 2008

When the difference between in and out is only a matter of a mm or two, it's not hard to see how accidental extubations happen. With some of these little stinkers, all they have to do is put their chin down a bit and presto! they're extubated. You can't hesitate over whether to pull the tube or not, because it's impossible to bag a baby up with a displaced tube, even if it looks like it's in.

ilstu99 · Sep 6, 2008

We use NeoBars, and yeah...sometimes they have to come off more quickly than I would like. Breathing is WAY more of a concern, though. So sometimes they end up with little red squares on their cheeks.

Take a look at how they have the tubes taped, and ask if they have a "quick release" method. We tape a certain way, that allows for quicker removal of the tape.

UTVOL3 · Sep 6, 2008

:chuckle

We use NeoBars, and yeah...sometimes they have to come off more quickly than I would like. Breathing is WAY more of a concern, though. So sometimes they end up with little red squares on their cheeks

We use these alot too, now. They are part of our VAP initiative. However, we had been using them for years before I ever actually saw a product demo poster for them. The recommended way to remove the little tape tabs is with plain H2O! Go figure. And if you use a little swab and do just like the poster instructs it really works pretty well. I also found out in an emergency to get a tube out fast you are supposed to take scissors and snip the plastic colored "bar" part. Where it gets just a little narrow. If you've seen them you know where I am talking about. Anyway we started trying that and it works pretty well too! We even started taping exactly according to the mfg instructions. I don't have numbers but management said our accidental extubations decreased a lot.

Kinda off topic but I just thought it was funny. Before we all were like I hate these stupid things! But then someone actually taught us how to use them and we're kinda likin them.

twizzlers67 · Sep 6, 2008

Thanks everyone for the info! Now I'll feel a lot better about taking a second to remove that tube (and save the cheeks) to get a good seal. Its reassuring to know that it can happen to anyone and I'm glad I'll know what to do! Thanks again :)

Pediatric Critical Care Columnist · Sep 7, 2008

Neobars used to have a fatal flaw. The area where the ends of the bar are sandwiched between the Duoderm and the outer layer of the cheek pads would separate and the tube would just twang right out. We stopped using them for that reason, and once burned twice shy. I don't think we'll ever see them in our hospital again.

elizabells, BSN, RN · Sep 7, 2008

Its reassuring to know that it can happen to anyone and I'm glad I'll know what to do! Thanks again :)

I've seen our respiratory guru MD (who is the one you call when no one can intubate a kid, even ENT or anesthesia, and also invented our wacky taping method) accidentally extubate a 23-weeker. So yes, it totally can happen to anyone.

NICU_babyRN, BSN, RN · Sep 9, 2008

We use NeoBars, and yeah...sometimes they have to come off more quickly than I would like. Breathing is WAY more of a concern, though. So sometimes they end up with little red squares on their cheeks. .

For all you neobar users, please be aware that there is a little "notch" on each side of the bar where it meets the duoderm that you can literally cut with scissors in the case of an emergency! if the neobar is on correctly, you should have enough space between the baby's face and the bar to slip scisors in. yes you have to be careful, but it is still faster than ripping the tape off!!

:nurse:

Mimi2RN, ASN, RN · Sep 9, 2008

We use Neobars, they work so much better than pink tape. We have very few accidental intubations, and don't have to spend time retaping the ET. I didn't know about cutting the bar for quick removal, so I went to the Neotech site, and found some helpful instructions.