How much movement does it take to dislodge a tube?

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Hello all-

I am new to these boards but I have been reading them for several months. I am a paramedic taking prereqs towards a BSN so I can eventually become (surprise) a CRNA.

I'm sure I will be asking everyone multiple questions about the profession and everything else you can imagine but this one is about ET tube placement: Paramedics, as you probably know, usually tube the pt while he is on the floor and then move him to a long spine board (if we transport). How much movement of the tube, would you say, does it take for it to be dislodged? I've heard it takes no more than a few millimeters. Is there any trick to moving a pt to avoid displacement (as when CRNAs move a pt to prone position for back surgery)?

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Specializes in Anesthesia.
......Is there any trick ........

Tape overdose is one.

.

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Depends on the size of the patient and size of the tube. Smaller patient and tube has a much smaller margin of error. In kids, just extending the neck can extubate them....

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quick rule of thumb guide...and something said has importance to be remembered.....ehem....

neck extention or flexion will move the tube 1.5cm.

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quick rule of thumb guide...and something said has importance to be remembered.....ehem...

Thanks for heads up. :D

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I've heard it takes no more than a few millimeters. Is there any trick to moving a pt to avoid displacement (as when CRNAs move a pt to prone position for back surgery)?

No, a few mm will not change anything. Another trick besides lots of tape, is support the head with one hand and hold the tube against the side of the mouth with the other during transport. Let the other members lift the patient. You're job is securing the airway.

Yes good post on how neck extension or flexion can move the tube 1.5cm and this can dislodge a tube if it's not in deep enuf (but this is rare). Usually in too deep. If the tube is sitting right at the carina, and youflex the neck you can easily Right mainstem the tube. Here is a pearl you guys will run into if you haven't already.

Lap Chole, tube is a little deep, maybe sitting near the carina. They insufflate the belly with Co2, pushes up on the lungs and mainstems your tube. Sats drop to about 90%, you look at the tube and it looks tape in the right place. You check your machine, sat probe, and everything else.

If you figured it out, answer is to pull the tube back 1-2 cm. It happened to me and I figured it out very quickly. It was a brand new experience for me and very elated to be able to fix it. This is what makes anesthesia fun!!

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I have yet to experience this as a significant problem with adults. it seems to be more of a problem in pediatrics with the smaller kids whereby with flexion you cause a mainstem and with extension you dislodge the tube. As said above we use a special tape job with the kids. I would venture to say that most anesthesia providers disconnect from the circuit when moving a pt to prevent the tube from getting dislodged.

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Specializes in I know stuff ;).

Well

I have dislodged a fair number of tubes due to my work environment. In peds, its a high risk possibiliy when moving. All it takes is flexion to have the tube right mainstemed and extention to have it sitting on teeth. Scary stuff.

As for adults. I have a funny story to tell.

I had intubated this fellow post MVC on a freeway. It was a grade III view due to some swelling so i used a bougie and got the tube. I felt like a hero as my medic partner tried and couldnt get the tube. Oh, was that going to change. We loaded the patient and as we slid him in on the aircraft sled i was by the head, stethescope around my neck. Once the patient was fully inside the aircraft, it is my habit to quickly check the tube with an EDD or EID due to the fact we moved him with a tube in place. I check it, still good. I am moving to go around the aircraft when my stethescope yanks and i almost fall over. I turn to look to see the tube dangling from my freakin stethescope. I reintubated but looked like an idiot.

When we arrived back at base my medic partner (we are very good friends) almost keeled over laughing! I was funny in retrospect!

The takehome point is that everything can remove an ETT. Just gotta be careful!

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Specializes in ER, Burns and Plastics.

Just a hint, as well. I currently work burns/plastics. We are the burn referral centre for the Martime provinces. A number of our burns come to us already tubed. A lot of facilities will cut the excess off the ETT after securing it. 24 hours later, due to the burn injury, the patient's head and neck have swelled considerably. Sometimes to the point of extubating the patient with no extra tube to advance and a 0% chance of re-intubating due to airway edema. All that is left to due is trach emergently.

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A lot of facilities will cut the excess off the ETT after securing it. 24 hours later, due to the burn injury, the patient's head and neck have swelled considerably. Sometimes to the point of extubating the patient with no extra tube to advance and a 0% chance of re-intubating due to airway edema. All that is left to due is trach emergently.

That's interesting! I know many providers who cut tubes. Certainly something to think about.

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Why wou you want to cut the tube? It wouldn't eliminate very much dead space or resistance, are they saying that its less likely to get yanked on if there is less outside the mouth?

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I agree. I can't see any good reason to cut the tube. Especially in burn patients! If this is a practice that would affect my patients or myself, I would quickly try to go to upper management of those involved departments to stop this practice. Sounds like you are endangering Burn patients by shortening their tube.

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