Dana

I have never heard of a concrete reason why talc shouldn't be used. Even if a pt. is trached or on the vent, the talc is used where it shouldn't be a problem for the pt.

In my experience, you're going to get skin breakdown no matter if you use the tape, twill, or bite block apparatus on the ETT. We use an adhesive holder that sticks very well re: the oral secretions. The best thing I've found is to retape, or resecure the ETT every day thereby alternating the side of the mouth that the tube leans toward. This avoids the severe breakdown (my God, lip repairs!! I've seen that on 1 patient in 18 years of ICU nursing and it was due to the RN and RT lack of attention being paid to the ETT).I don't know that there's a 100% solution to this problem. I think that it's one of those things that just requires diligence. A trach after being on the vent for 3-5 days seems way to early to me.

I believe it's 2-2 1/2 cc. I suppose you could give it in the deltoid, but I think the gluteal or thigh are more comfortable. I generally don't use the deltoid, I feel the bigger muscles are safer.

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