I need input from nurses working in burn unit about securement of ETT in patients with facial burns or smoke inhalation injury? Any idea is welcomed.. Thank you.
May 18, '07
We use trach ties x 2. Place cloth tape around ett, not silk, with all the secretions silk will fall right off. Tie one tie in knot x2 to ett and wrap around head over ears and tie. Second tie also goes around ett x2 & then bring around head under ears & tie. Hope this helps! We change as needed with dressing changes. In beginning of burn injury pretty often due to facial swelling.
May 18, '07
Thank you for the info. Our PICU just opened doors to burn patients and we are in the process of developing a protocol to secure ETT and decrease the occurence of accidental extubation in these patient population considering, not only the risk of extubation, but also the difficulty in re-intubating them. One of my follow-up questions to your method is about the frequency of tie changes. How often does that majority of the time? BID, every 2 days? We use most often than not Bacitracin ointment on facial burns. Does this method withstand the concoction of ointment, secretions & serous drainage? Do you have other guideline special to your unit like mandatory nasal intubation for all burn patients, cuffed ETT, RT practices? Quite a number of questions here..hope you won't tire out.:spin: Thanks a bunch!
May 21, '07
Initially we usually change ties with every dressing change - twice a day. Our patients use primary silvadene to the face, unless grafted then they have sulfamylon soln with exudrys. If they are grafted all over the face they will sometimes anchor the tube to the jaw then no ties are needed. Our patients are rarely nasally intubated. They are typically intubated about 3 to 4 weeks & then trach. We have our own respiratory therapists designated to our unit. They handle the cuffs, only peds under 8 are not cuffed ett. We both take turns suctioning patients. I love caring for burns! Bring on the questions.
Jul 21, '07
We use cloth twill tape and change them PRN. We use Bacitracin on our face burns unless they are deep second or third, then we use Mafenide solution.