Securing ET tubes

[javajunkie]

Hello everyone,

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/product...y=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.

Any input on this subject is greatly appreciated.

Thanks in advance!

[gwenith, BSN, RN]

We sometimes use ETADS when ties are causing breakdown and you do see it especially if the patient has an underlying predisposition to cold-sores. It often depends on how tight you tie the cotton tapes and how much the patient is moving around the bed. We always "pad" our ties with foam but we still occasionally get burn/breakdown. Big problem with cotton ties is they make access to mouth care more difficult - esp. if you have a LOT of padding LOL.

I worked in a regional hospital that took adults and children so we used to use a variant of how peadiatric ETT's are secured and it was very effective and seemed to cause less problems than many of the other alternatives.

What we could do is "prep" the skin with er with cavilon or even Tinc Benz Co and then using only red elastoplast tape ( you know the type a heavy non stretch tight woven material tape) we would tape the tube to the face. I used to demonstrate how to do this with the manikin and was able to hold the manikin off the floor by the ETT tube without the tube changing position!!!! Unfortunately ties are more commonly used here in this city and woe-betide the nurse who dares differently!!! Still there are a couple of us who are going to try quietly and persistently to change that.

[teeituptom, BSN, RN]

Just plain old safely and securely

I like Mastisol and adhesive tape

of course it never comes off

[gwenith, BSN, RN]

Mastisol??? What is that Tom - I have never heard of it - of course we may have it under another name...........

[carcha]

we use sleek, unless the patient is alergic to it, or sometimes a ribbon gauze, however our patients are in one position throughout the case and are usually extubated following the case.

[gwenith, BSN, RN]

Sleek is used a lot in theatre over here too but since it stretches it is no good for a lightly sedated patient who may make sudden moves.

To be honest I hate sleek about the only thing I will sue it for is repairing air mattresses

[icu_rn_bsn2000]

I prefer the tape because the "duoderm" type always slips over the top lip of the patient.

Louise

[Zee_RN, BSN, RN]

We use the Hollister "duoderm" style endotube holder. Yes, sometimes it does slip over the top lip but I've never seen skin breakdown from it. We just change 'em when it slips.

At my last ACLS class, they said tape was no longer "approved" for endotube securing (approved by whom?). Not sure where that came from, though. May have something to do with the Ventilator-Acquired Pneumonia Outcome Measures that JCAHO is interested in. I only say that because we are doing ventilator QA daily and one of the questions that is to be addressed is "is endotube secure?"

[angelawangyixin]

Hello Javajunkie,

The ETAD sounds really interesting. Could u check out for me how much it costs perpiece and where it is manufactured...

may speak to my nurse manager about it...

Most of the patients will have skin breakdown around the lips..

i would like to recommend it...

Cheers

Angela