ET tube questions

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I'm fourth semester nursing student and an ICU nursing assistant. I'd like to know a little bit more about ET tubes, in particular, how much the can be safely manipulated during pt. positioning etc. Thanks guys.

Warmest Regards

This C-collar thing seems to be a common paramedic thing, but it really doesn't do anything to secure a tube.

Sure it does... flex the neck and the tube tip moves caudad. Extend the neck and it moves cephalad. Add lateral flexion or extension introduces more chances of dislodging the tube. We don't use c collars in the unit, but if we move a patient without stabilization of the neck and head, the risk increases. It's the principle that applies if not the actual technique.

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Specializes in Family Nurse Practitioner.

Before moving an intubated patient make sure that it is even safe to move the patient especially independantly -ask the RN. Pretty much give the tube some slack with the tubing. The tube shouldn't move unless its pulled.

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Working in a large city trauma center I see many different EMS agencies. It seems the ones who use the collar have the least amount of protocols or skills to control the ETT after intubation. The other issue is the blue Thomas ETT holder. Too bad some in EMS have to be so different they don't want to see what others who do transport use.

I would hope if you have intubated thousands and thousands and thousands of patients, you would be able to secure an ETT and provide the necessary follow up medications to ensure that tubes security. I have done flight and CCT for many years and have never used a c-collar to secure an ETT. In fact, if an ICU or ER where we picked up the patients ever saw us doing that, they probably would vote no confidence and seek out another CCT. This includes our neonatal and pediatric transfers.

I also find those who say they intubate hundreds or thousands and thousands and thousands of patients usually average less than 5 tubes a year. The exception would be CRNAs.

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Working in a large city trauma center I see many different EMS agencies. It seems the ones who use the collar have the least amount of protocols or skills to control the ETT after intubation. The other issue is the blue Thomas ETT holder. Too bad some in EMS have to be so different they don't want to see what others who do transport use.

I would hope if you have intubated thousands and thousands and thousands of patients, you would be able to secure an ETT and provide the necessary follow up medications to ensure that tubes security. I have done flight and CCT for many years and have never used a c-collar to secure an ETT. In fact, if an ICU or ER where we picked up the patients ever saw us doing that, they probably would vote no confidence and seek out another CCT. This includes our neonatal and pediatric transfers.

I also find those who say they intubate hundreds or thousands and thousands and thousands of patients usually average less than 5 tubes a year. The exception would be CRNAs.

I'm a CRNA, Sport.

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Specializes in EMT since 92, Paramedic since 97, RN and PHRN 2021.
Working in a large city trauma center I see many different EMS agencies. It seems the ones who use the collar have the least amount of protocols or skills to control the ETT after intubation. The other issue is the blue Thomas ETT holder. Too bad some in EMS have to be so different they don't want to see what others who do transport use.

I would hope if you have intubated thousands and thousands and thousands of patients, you would be able to secure an ETT and provide the necessary follow up medications to ensure that tubes security. I have done flight and CCT for many years and have never used a c-collar to secure an ETT. In fact, if an ICU or ER where we picked up the patients ever saw us doing that, they probably would vote no confidence and seek out another CCT. This includes our neonatal and pediatric transfers.

I also find those who say they intubate hundreds or thousands and thousands and thousands of patients usually average less than 5 tubes a year. The exception would be CRNAs.

and when you've been doing this long enough things add up. But really that's not saying much about your ICU or ER if you do everything you can to secure a tube and they would not have confidence in you of your team. In a bouncing moving ambulance, especially the roads in Philly , I will take all the security I can get.

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I'm a CRNA, Sport.

Did you actually read my post or just touchy about the thousands and thousands and thousands of intubations comment? I did say CRNAs were the exception.

Most Paramedics even in busy systems rarely get more than 20 intubations a year. Some get ZERO. Sometimes their medical directors or the state won't give them the protocols to maintain a tube properly.

Now that I know emtpbill is from Philly, that explains why he has a more difficult time securing and keeping a tube.

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and when you've been doing this long enough things add up. But really that's not saying much about your ICU or ER if you do everything you can to secure a tube and they would not have confidence in you of your team. In a bouncing moving ambulance, especially the roads in Philly , I will take all the security I can get.

Are you saying since my ICUs and ERs, yes plural for a large hospital, don't c-collar we don't deserve a vote of confidence? Obviously you have not seen a real transport team in action. Yes we go over bumpy roads also but we have confidence in our knowledge of anatomy, ETT confirmation, securing devices and the ability to manage a tube after ETT placement that we don't have to put a patient through c-collar placement. Haven't you read anything related to EMS and c-collars in the last 10 years? They aren't being placed on everyone anymore.

Okay sorry. Maybe I shouldn't be so critical on you now that I know you are from Philly especially if that is the only place you have worked. Sounds like that system has as many problems or maybe more than Washington DC Fire EMS.

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Specializes in Critical Care.
Really not much to say. Make sure it's at an appropriate depth, check lung sounds, confirm it's well secured and make sure it stays there. I will say that my personal practice is disconnecting the circuit from the tube for brief turns or bigger changes in position. Beyond that, just don't let it come out.

You're disconnecting the circuit for repositioning?

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That's what I do

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Specializes in Critical Care.
You're disconnecting the circuit for repositioning?

Breathing is overrated

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