ETT tape and tape changes

[Celia M, ASN, RN]

We are experiencing some difficulties with tape burns and reactions with the manufactured tube holders (Dale) we are currently using. I'd be grateful if anyone out there is having difficulty could let me know. Also how often do you routinely change them and what necessitates a tape change. Thanks :)

[bobnurse]

We had that problem and went to the commercial tube holders...We havent had a problem since....No tape what so ever.........You might consider it......We use the hard plastic one that has the clamp to hold the tube, you velcro it to their head. It has the bite block built in so they cant bite on the tube, and it makes oral care much easier.

[gwenith, BSN, RN]

Where possible we use E-Tads but not everyone is suitable for them.

[begalli]

Hi, we don't use Dale tube holders but occassionally we use another brand that stinks! I can't think of the brand name, it has duoderm-like patches that are applied to each cheek and a rigid plastic part in between the duoderm-like things that sit in the space between the patient's nose and upper lip. Then it has a plastic part that comes down that has an adjustable strap to hold the tube in place. There isn't anything that goes around the back of the patient's neck.

The only good thing about these tube holders is that we are able to release the tube and move it from side to side for repositioning in the patients mouth. We are suppossed to use these on long-term intubations, but what ends up happening is the rigid plastic part cuts into the space above the patient's upper lip!!!!! We had a neuro patient whose head was in constant motion and she ended up with a huge gash from the tube holder! Also, the duoderm type patches that are suppossed to hold the appliance to the patient's face hardly ever stick completely. You know how ICU patients get really oily skin? The ends of these patches always end up curling up. I don't mean that the entire thing comes off, but it's just so ugly especially on elderly patient's whose faces are sunken already from old age. Terrible, simply awful and horrible! I never put these on my patient or if they have one I replace it with tape.

99% of the time we use tape. In long term intubations, we retape every couple of days to reposition the tube on the patient's lip (from right - left - center of the mouth). We will also re-tape if the tape becomes soiled.

I wish we had a better device like bobnurse uses, especially for the long-term ventilated patients. WIth all the technology we use, you'd think that the hospital would get it together! Seeing an occassional blister or pressure ulcer on a patient's lip from the tube is unacceptable!

[begalli]

Where possible we use E-Tads but not everyone is suitable for them.

YIKES! They're called Etads! And they do have something that goes around the neck.....see how much I use them?! I hate that plastic thing in the middle of the front above the round thing that secures the tube. HATE these!

:chuckle Sheesh! I sound pretty harsh about these things.

[oakmax]

We use elastoplast tape and prep the skin with no-sting skin barrier. Change the tube nightly side to side. Not too many complications

cw

[bobnurse]

Here is a picture of the device we use..........It is called the thomas ett holder. As you can see, it keeps the tube off of the lips. We change them when they get soiled, or every 72 hours or so.

[mattsmom81]

Call me old fashioned...but unless its against policy, I still prefer tape and use skin protectant or benzoin underneath if there's a skin issue.

Our RT shares responsibility with the nurse regarding oral care, retaping, skin inspection etc in my area. We don't have too many problems as we tagteam, retape and reposition ETT prn and do major oral care together, etc.

[gwenith, BSN, RN]

The only time I have seen someone hurt from an Etad was when it was put on upside down:chuckle Otherwise we like them. We don't have the thomas ones available here in Australia. We sometimes get the problem that products you have there will not be shipped here because "there is not a big enough market"

I am finding it interesting who many people like tape over ties (I personally do but no-one in the city at the moment does:(). It actually would be great if we could add a poll to this thread (I could if I put my mod hat on) and run a poll at the same time.

[zambezi, BSN, RN]

We still use tape...we tried the holders for awhile but for some reason didn't stick with them. Our RTs usually change the tape...and the side that the tube is on...usually about every 2-3 days or so...we are the one primarily responsible for oral care...