I would like to gather everyone's thoughts regarding the BEST way to secure endotracheal tubes. Until recently, the standard method for securing ETT's in my facility has been good old cloth tape.
A few months ago, we began trialing Hollister Endotracheal Tube Attachment Devices (ETAD). For those of you who are unfamiliar with these, try to imagine: They consist of an adhesive "duoderm-like" facepiece that sticks to the patients upper lip and extends to the cheeks. There is a cloth strap that extends around the back of the neck for added support. The ET tube itself is held in place, also with an adhesive holder which is connected to the facepiece by a "track" which allows the tube to be easily repostitioned as often as needed. (Go to: http://www.hollister.com/us/products/product_series.asp?group=2&family=13&series=141 for a link). The major selling point for this device is reduced oral skin breakdown (because the tube can be easily repositioned).
My experience with the ETAD has included an INCREASED incidence of lip breakdown, the device tends to slip if the patient is sweaty, difficulty changing from one ETAD to another, and the general thought that these deviced probably cost an arm and a leg.
So my question is this: In your facility, what is the preferred method of securing ET tubes? What do you think (or know) are the benefits (or drawbacks) of the various methods?
The way I see it: Tape is cheap, easy to change, and I personally have not seen any incidences of skin breakdown beyond a very few incidences of tape burn.
