ET tube

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hi

i went help what is right way to fix ET tube ?

Thank

Specializes in Neonatal ICU (Cardiothoracic).

OK, I'll try to describe it better.... The "wing" thing is the neobar, used for bigger babies... The X is a separate device, which we use exclusively in our unit. (2 separate products) They can be used with 2.5-4.0 ETT's.

In the center of the x is the hole for the ETT, open to one side of the X

The X sits at either corner of the mouth, with one "leg" over the top lip, and one under the bottom lip, and the opposite two across the cheek. The ETT is placed in the "notch" ( -> X ) of the x, and a special plastic piece locks it in place.

Hope this helps!

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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!

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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. ;)

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Specializes in NICU.
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! :(

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Specializes in NICU- now learning OR!.

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

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Specializes in Neonatal ICU (Cardiothoracic).

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....

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Specializes in Level III NICU.
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.

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Specializes in NICU- now learning OR!.
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

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Specializes in neonatal.

hi! its really hard to imagine! do you have any picture of that?

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Specializes in NICU.

"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 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.

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Specializes in NICU.
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...

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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"

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