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OGT securement in intubated patients

Posted

Specializes in ICU/CVU. Has 8 years experience.

We usually, as a standard, tape the OGT to the ETT (still being able to visualize cm markers and tube size markers etc...).

Anesthesia, now, does not want anything taped directly to the ETT.

My question for everyone is, what is your standard for securing OGT's in intubated patients?

Penelope_Pitstop, BSN, RN

Has 13 years experience.

We, too, tape the OG to the ETT. I'm trying to think of another way and I simply cannot! I would be afraid to do mouth care if we taped OGs like NGs, for example.

We do it to the ET tubes also. You need to ask anesthesia how they would like the OG tubes secured. The need to help with a solution since they are causing the "problem".

Not sure what type of tube securment your using, any way to use that for securment while not being on the tube?

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

We too tape them to the ETT.

spacemonkey15

Specializes in Critical care. Has 10 years experience.

We tend to use a film dressing to secure the OGT to the corner of the mouth, though it's rare we use them.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 40 years experience.

ETT...where else would they like them?

We usually, as a standard, tape the OGT to the ETT (still being able to visualize cm markers and tube size markers etc...).

Anesthesia, now, does not want anything taped directly to the ETT.

My question for everyone is, what is your standard for securing OGT's in intubated patients?

Why does anesthesia get any say in an ICU patient? How does anesthesia secure OGs when then send them from the OR? I would bet its taped to the ETT. We have a tube holder to secure the tube and then tape the OG to the ETT.

SubSippi

Has 2 years experience.

Why does anesthesia get any say in an ICU patient? How does anesthesia secure OGs when then send them from the OR? I would bet its taped to the ETT. We have a tube holder to secure the tube and then tape the OG to the ETT.

Right on.

We also tape to the ETT. In my experience, anesthesia has pretty much zero involvement with the patients once they leave the OR. So they can make their demands, but how would they even know?

Also, it's not an order, it's not a policy, it just their request at this point, right? Once they report off to you that patient is in your care, and it's your decision. I could see if the attending didn't want you to do it, but anesthesia? Give me a break!

JeffTheRN

Specializes in ICU/CVU. Has 8 years experience.

I agree with everyone and we still continue to tape to ETT's until my boss tell's me not to. When anesthesia drops off a post op CABG or valve in the CVU, the OGT is free floating and not secured in any way, but they're usually extubated within a few hours or later that night anyhow. Thanks all.

I tend to think that if the OG is taped to the mouth or face, it would increase risk for DPUs.

We tape ours to the ETT securement device, not the actual ETT.

essT

Specializes in NICU. Has 5 years experience.

We secure to the cheek with tegaderm. Apparently there was an accidental extubation caused by a patient pulling out their OGT and the ETT coming with.

delphine22

Specializes in Quality, Cardiac Stepdown, MICU. Has 5 years experience.

Tape to ETT. I always try to do a chest-tube-style tape, meaning I fold down the two free ends of the tape so it's easy to take off if necessary.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

Mark OGT with a sharpie post PCXR to monitor placement ATL and secure with tabbed silk tape so that both tubes are rotated side to side.

You can also add another movable clamp to the Hollister ETAD and use it to secure an OGT , Linton, Minnesota or Blakemore tube.

Usually after anesthesia intubates a patient, we never hear from them again, so I don't k ow their opinion on it. Now, our RTs sometimes complain if we don't leave a 'courtesy' flap or cover up markings. A courtesy flap (in case you don't know) is when instead of fastening the last end of the tape to the ETT, you double back a little piece. This makes it so you can easily take it off. I can't see why they would ever care, except for if you don't leave this flap and you can't take the tape off, so it can't be repositioned. Our hospital doesn't have a policy.

Rebecca Carter

Specializes in CVICU. Has 36 years experience.

I too am use to securing to ETT as I feel it is more secure and less able to slide out of place or be tongued out of place by patients. When anesthesia has these patients, they ARE NOT AWAKE!. Therefore, they are not dealing with placing meds down an ETT that may or may not have moved because it has curled or looped in the patient's mouth or been tongued forward by restless patients. We did have an incident years ago where a patient self extubated by grapping the feeding tube which was within his reach. RTs answer was to ban taping of the ETT despite the fact that the in-line suction devices are as much a danger for the patient to wiggle down in the bed and grab. So, they made that an "unofficial policy as part of their action plan. Of course anesthesia agreed because that is what they are also use to. Regardless, the nurse has to use this OGT for meds in alot of cases and cannot be 100% assured that it has stayed in place since the last xray. Also, there are only suggestions as to how to secure to the face, not a policy or manufactured device. So, some are taped, some with op-site and some with NGT holder devices. None of these keep the OGT secured as well as taping to ETT. Sometimes these are barely staying secured to the face and are half way off when I enter the room due to sweat or beard stubble. The policy should be how to keep the OGT secured above the shoulders so pt"s can't grab at it or the inline suction catheter that I frequently find sitting on the pt's chest. That is the real problem!

Edited by Rebecca Carter
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