what is the best practice for rotating the ETT

VANurse2010 · Mar 3, 2015

I have done searches on CINAHL, AACN, google scholar and the manufacturers' websites and I have not been able to find anything about the best practice for rotating the ETT to prevent pressure ulcers in pt's with a Hollister or similar device.
The second part of my question is is this considered strictly an RT responsibility at your institution?
I have always tried to assess for skin breakdown and rotate the ETT with q 4 hr oral care using the Sage or Qcare products. If anyone can direct me to a critical care site with a definitive best practice for rotating the ETT, it would be an immense help. Thank you very much.

If I felt the ETT needed to be rotated, I would ask RT to assess and rotate if appropriate. At my hospital, that tube is considered "theirs." Just as they don't mess with my (e.g.IV) lines, I don't go "messing" with theirs.

Funny you should mentioned oral care, but the RTs where I work are working on a project to reform oral care. The VAP rates have actually gone up since an oral care bundle was instituted a few years ago.

Here.I.Stand, BSN, RN · Mar 6, 2015

I haven't read anything about this specifically, but where I work we rotate the ETT q 2 hrs with oral care. If the RRT is in the room, they do it; otherwise we RNs do it as part of the overall pressure reduction plan.

MunoRN, RN · Mar 7, 2015

We do oral care every 4 hours (and prn) and the ETT is repositioned with oral care. Both RN's and RT share responsibility for oral care, when possible we alternate (RN does it q 8 hrs and RT does it q 8 hrs). As far as I'm aware the recommendations vary depending on who you are listen to and are usually either 2 or 4 hours.

NPOaftermidnight, MSN, RN, NP · Mar 15, 2015

We are old school (or really cheap?) and use tapes, not tube holders, so we rotate q24h when tapes are changed. Compared to q2h/q4h this seems inadequate but we don't see ETT-related pressure ulcers very often so I guess it's working for us. Also, this is completely a nursing responsibility.

On a side note, we are trialing ETT holders soon. Any ones you love/hate?

LargeMarge · Mar 16, 2015

At my previous job 2 years ago the policy was for the nurse to rotate the ETT once every 24 hours and it was the night shift responsibility to do it and document.

dah doh, BSN, RN · Mar 16, 2015

The RT typically moves the ETT every shift & PRN. We share the duty of oral care.

Our facility uses Hollister ETT holders. They tend to slip more if the patient grows facial hair, doesn't have teeth, cachetic, or has facial trauma. We do seem to have less skin breakdown when used correctly.

AnthonyD · Apr 16, 2015

I believe it is recommended to reposition Q2hrs with oral care.

If you're using the Hollister Anchorfast product, their instructions state: "Reposition the endotracheal tube side to side at least every two hours (or more frequently if the patient's condition dictates) tominimize the risk of injury to the skin and/or lips from unrelieved pressure"

ref: https://www.hollister.com/us/files/care_tips/tips_Anchor%20Fast%20Oral%20Endotracheal%20Tube%20Fastener_1.pdf

AngelRN27 · May 8, 2015

Our facility has a q4hr oral care policy (also shared between RN/RT when possible) but our policy for rotation of the ETT is qshift and PRN as someone mentioned above. We also use the Hollister holder as another poster mentioned. My facility hasn't had any ETT related breakdown for over a year, per administration, so I guess this policy/technology works. Generally, the tube "belongs" to the RT's, but depending on the pt load, the shift, what's going on-- RN's can rotate the ETT if need-be. Our RT's are big on teaching, so the majority of our RN's feel very comfortable with tubes. You should never go all-in if you don't feel safe or are unsure at all of the best practice. I prefer to have someone in the room with me (another RN or grab any RT) when moving the ETT, just in case...