Need suggestions for Ett taping methods to help reduce self extubation rates

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Specializes in Critical Care.

dear fellow nurses,

i'm working in the sicu in singapore for three and a half years till date. there are many self extubation cases that happened in my ward as patients are either restless or their cough are very strong till they can cough out the tube. any suggestions of different ways to tape the tube down? how are the extubation rates in your hospital or wards? we only have dura-pores (silk tapes) and zinc oxide tapes and had tried taping around the neck to secure but self extubation rates are still on the upward trend. :crying2:

we even tried restraining patients but patients can still find means and ways to pull out the tube themselves. we have mouth guards that is only used in the emergency dept for trauma patients.

can anyone help? it would be even more helpful if anyone could attach pictures or articles.

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a simple leucoplast can be cut into three (but leave at least half an inch so the three are still together). stick the upper strip between the upper lip and the nose. loop the middle strip around the ETT. stick the lower strip on the chin. this is for ICUs with tight budgets

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Specializes in Neurosurgical/Trauma ICU, stroke, TBI,.

Sedation? Breathing through an ETT is like breathing through a straw. Why aren't these patients sedated with propofol, ativan, fentanyl, etc?

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Patient comfort will prevent most of those unplanned extubations.

CXR confirmation is also an absolute necessity. Many patients come out of the OR with the tube high to where it just takes one cough and the cuff is above the cords. Some patients even have the cuff above the cords just enough to make a seal and actually are not through the cords.

This is how our tapes look regardless if we use a commercial device or tape. We also us "wetproof" tape.

http://www.google.com/imgres?imgurl=http://www.bandb-medical.com/content/11010/11010-0.jpg&imgrefurl=http://www.bandb-medical.com/content/11010-0_et.htm&usg=__hMOGPuDbDU1VpAElsg65FSKjMac=&h=200&w=200&sz=7&hl=en&start=0&sig2=6XYpxpRpKXyGyA3BL3TZew&zoom=1&tbnid=cTevM5VaHFFWDM:&tbnh=130&tbnw=130&ei=JrDqTJfIPJOosAOfysiwCw&prev=/images%3Fq%3Dendotracheal%2Btube%2Btaping%26um%3D1%26hl%3Den%26biw%3D1436%26bih%3D694%26tbs%3Disch:1&um=1&itbs=1&iact=rc&dur=531&oei=JrDqTJfIPJOosAOfysiwCw&esq=1&page=1&ndsp=29&ved=1t:429,r:3,s:0&tx=80&ty=65

This device is what EMS uses and we can't get that thing off our patients fast enough. Too many in extubations or kinked tubes with it not to mention breakdown of the mouth and no way to do good oral care.

http://www.google.com/imgres?imgurl=http://2.imimg.com/data2/NB/TM/MY-2048912/21-250x250.jpg&imgrefurl=http://www.indiamart.com/hindustanlifecare/anesthesia-respiratory-and-icu-products.html&usg=__d85lcJClOx_3wiFhBBvV6VE9pzg=&h=250&w=250&sz=6&hl=en&start=0&sig2=WNURw6leKox_fGUJn-w0UA&zoom=1&tbnid=ze_0fUaCLPZS5M:&tbnh=128&tbnw=171&ei=JrDqTJfIPJOosAOfysiwCw&prev=/images%3Fq%3Dendotracheal%2Btube%2Btaping%26um%3D1%26hl%3Den%26biw%3D1436%26bih%3D694%26tbs%3Disch:10%2C312&um=1&itbs=1&iact=hc&vpx=1060&vpy=193&dur=141&hovh=200&hovw=200&tx=112&ty=137&oei=JrDqTJfIPJOosAOfysiwCw&esq=1&page=1&ndsp=29&ved=1t:429,r:27,s:0&biw=1436&bih=694

http://www.google.com/imgres?imgurl=http://www.safetytec.ie/mueller/catalog/images/Thomas-Tube-Holder.2.jpg&imgrefurl=http://www.safetytec.ie/mueller/catalog/index.php%3Fmain_page%3Dindex%26cPath%3D25&usg=__G7JDV3ASnhrvh0IkUvirklowf5o=&h=964&w=640&sz=23&hl=en&start=97&sig2=gK8nLxA3BBIa3YbZtfcntA&zoom=1&tbnid=0JzM4WXczXm12M:&tbnh=130&tbnw=86&ei=17HqTJKyMYbCcaeQ7f0K&prev=/images%3Fq%3Dendotracheal%2Btube%2Btaping%26um%3D1%26hl%3Den%26biw%3D1436%26bih%3D694%26tbs%3Disch:10%2C1457&um=1&itbs=1&iact=hc&vpx=406&vpy=323&dur=15&hovh=276&hovw=183&tx=107&ty=187&oei=JrDqTJfIPJOosAOfysiwCw&esq=5&page=4&ndsp=35&ved=1t:429,r:2,s:97&biw=1436&bih=694

For long term comfort (besides meds) I like this device.

http://www.dalemed.com/Products/EndotrachealTubeHolder.aspx

For patients who have IJs or they will get on like in the ED, I also tape over or above the ear rather than going around the neck. This prevent contamination from wet soggy tape around your line dressing. It also keeps the tape around the neck from getting dirty from drool and vomit.

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I would say pt comfort would be the biggest issue here. But also good oral and tube care. We do at least q4 mouth care. Not only does it prevent VAP but also helps with secretions in the mouth that patients attempt to cough up. Also how long have these people been tubed? I realize that its out of your control really but are trachs a possibility?

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Specializes in General 9yrs; Ortho-2y Intensive Care-6y.

You can mark the cm. no where the ETT should stay in the mouth/edge of lip with a sleek/tape and tie the tube with ribbon like cloth tape where the mark is and tie it around the patient's head. One end longer than the other. The longer tape is goin' to pass his upper lip and put sleek about 1 inch on pt's cheek bone area-pull white tape over sleek and put another 1 inch sleek tape over the first one, pull the white tape around pt's upper ear w/tape all way round his head pass down the lower side of the other ear and connect and tie it with the other end on that side of pts face(use double knot) and leave 2 finger breaths. Don't forget to put another 1 inch sleek on pts skin where you will do the double knot then cover it with the same. Then you can cut the rest of the tape that dangles.

In my unit, only 2 self extubation last year---those patients are the psyche ones.

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