Knicked et tube balloon tube while shaving

[KellyMPH]

So yesterday I was shaving my patient since he looked like no one had given him a bath in a long time and his facial hair was crusted with disgusting secretions. I was very careful to move the tube that you use to inflate the et tube cuff out of the way. At the very end the tube fell back on his face right as I was removing the razor and finished and unfortunately it knicked the tube and cut it partially. What a freak accident! I immediately heard the leak and notified respiratory. Respiratory arrived and asked me to go grab a clamp, went to ask another nurse for some kelly clamps and this nurse kept asking me what for (she is the unit nosy busy body masquerading as a kind concerned nurse). I briefly told her while she was grabbing the the clamps and she said you have to replace the tube in some accusatory fashion like I was just going to clamp it and walk away. I gave the clamps to respiratory and the patient was not in distress. MD was notified and he laughed and called me the "shaving master" and said it was OK and the patient's et tube was changed out for a new one. During this time the patients spo2 remained in the high 90's, resp rate did not increase and he looked comfortable. The Charge RN filled out an incident report. I overheard the night/day charges giving report and heard the night relay what happened and state "she just decided to clamp it" and several other gossipy statements. After I finished taking my report I immediately went to the charge RN and in front of the night charge stated I'd just like to clear up the facts so there's no confusion going around that I did not just decide to clamp it and that's it, respiratory clamped it while waiting for anesthesia to come change out the tube.

1) Does your facility require an incident report for something like this? 2) Would you have done anything differently in the immediate moment after? 3) would you have addressed the "unit gossip" differently? 4) anything else I can learn from this experience?

[chare]

2 hours ago, KellyMPH said:

[...]

1) Does your facility require an incident report for something like this? 2) Would you have done anything differently in the immediate moment after? 3) would you have addressed the "unit gossip" differently? 4) anything else I can learn from this experience?

1) Yes. Are you thinking that this wouldn't require one being submitted?

2) No. And, based upon the delay you described in obtaining the clamp, the cuff had most likely deflated long before it was clamped.

3) No. I think you handled this appropriately. If you hear staff members discussing this in the future do as you did here, and explain what you did, and why.

4) Rather than shaving him, do you think washing his beard might have been a better option?

Best wishes.

[lexotaNIL, BSN]

know that there are always different types of personality in the unit...Just know when to turn on your tough for things like that. regarding the incident, normally yes, there must be an IR. For the tube so long the patient is okay, the RT is calmed and so as the resident, no worries but better careful next time. The quality management is happy to receive an IR., get used to it okay? but that doesn't mean Repeat the same mistake hahaha what I mean is IR is part of being a bedside nurse.

[nurseflip26, CRNA]

It wasn't your question, but for future reference they do make an ETT pilot ballon repair kit that could be used if the patient was a very difficult intubation or exchange is undesirable for some reason.

[adventure_rn, MSN, NP]

On 5/16/2020 at 7:37 AM, KellyMPH said:

I gave the clamps to respiratory and the patient was not in distress. MD was notified and he laughed and called me the "shaving master" and said it was OK and the patient's et tube was changed out for a new one.

We had something really similar happen in my unit. A pretty sick baby had just rolled back from an interventional cath, and while the entire team in the room, our very experienced RT straight up cut the balloon in half (I'm not quite sure what he was aiming for). He was a bit embarrassed and we teased him for about two seconds, but we just reintubated, the patient was totally fine, and nobody thought any less of the RT.

The thing is, stuff like that happens. Sometimes the most experienced people do dumb things, and sometimes freak accidents (like the one you described) make us look like we've done something dumb. It happens to everybody.

Even if people are talking about it, I don't think it's something that will follow you. Assuming this was just an isolated incident (not part of a sequence of similar issues), I doubt that anybody will think less of you overall.

At the time, it might have been beneficial for you to pull the specific nurses aside and calmly explain what had happened as well as your thought process. It's way easier to nip it in the bud at the moment than to do it after the fact. Just make sure that you present it in a way that isn't purely defensive, because that will only make things worse.

It's important to write an incident report for stuff like that, because that's how we track system-wide errors and make changes. It could be that your experience isn't uncommon, and that there should be a policy change related to shaving intubated patients.

For the record, I think it's really admirable that you went out of your way to attend to the patient's hygiene. That stuff can easily be overlooked, or left for the next shift. It stinks that the actual process went pear-shaped, but it's still very thoughtful that you made the effort to do a good job for your patient.