Securing ET tubes

RONDIN · Dec 19, 1998

WORKING IN MANY DIFFERENT CRITICAL UNITS I'VE SEEN VARIOUS ETT HOLDERS.FROM MY EXPERIENCE THEY WORK WELL, THE ONLY PROBLEM IS WITH SECRETIONS FROM THE MOUTH AND THE SHEER PRESSURE OF THOSE DEVICES, THE SKIN INTEGRITY BECOMES AT RISK. THIS CAN ALSO OCCUR WITH TAPE, BUT THE PRESSURE ISN'T AS MUCH. JUST MY OBSERVATIONS.

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RCC

mcline · Dec 20, 1998

Skin breakdown is our concern too with the tape and twill tie methods. We see corners of the mouth breakdown with the tenstion from the twill tie method and with the tape method our concern breakdown from the adhesive. Have you seen this in your practice. Also with the holder the brand that we have looked at has a built in bite block and a NG tube holder too. What is you experience with this??? thanks

randygrady · Dec 25, 1998

We use holders and have had trouble with pts having to have repair of lips after extubation. yet with tape pts have bit a hole in et tube. i think for intubation over 3-5 day a trach is the best cure. and after transfer to the floor the trach can be pulled and allowed to heal over. we have 1 copd pt that has had trach 3 times

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Canrckid · Dec 25, 1998

randygrady.....

Haven't you ever heard of putting an oropharyngeal airway in with an ET tube so that patients won't bite the tube? A trach as a solution for a 3-5 day intubation? After nearly 30 years in critical care, I have had only one patient bite a hole in a ET tube, and he didn't have an airway....

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Dana · Jan 11, 1999

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.

Shotgvr1 · Jan 17, 1999

On my unit, we use the twill ties to secure an OETT. Many of us nurses use duoderm in the corners of the patients mouths. We have found this to help reduce the breakdown that can occur in the corners of a patients mouth. I heard that my unit had looked into using some type of ETT holder, but that it was a lot more expensive for the patient.

barb o · Mar 2, 1999

We use adhesive tape but make sure to change positions every day or two, or when the tape becomes really gross from secretions. If this is done religiously, chances for breakdown are minimized. The only tube holder I've had experience with was one that also had a spot for the NG tube. Unfortunately, it had a tendency to "travel" out so that a tube secured at 21cm may quickly go to 19cm, etc. Wasn't impressed.

LRichardson · Mar 2, 1999

We tape our ETT and use a bite block... we tried the holders and had a horrible time doing complete mouth care.. oral secretions were almost impossible to get out.. as well as the slippage that someone mentioned earlier..

We rotate our ETT AT LEAST once every 24 hours.. more often if need be...i agree with the earlier comment.. breakdown seems to occur when we quit paying attention or fail to intervene.. if we have the beginnings of skin breakdown on the upper lip then we tape to the nose for a few days or visa versa..

We normally trach patients between 12 and 15 days..

KReinhard · Apr 10, 1999

I agree with LRichardson, it is the attention that we pay to the ETT that helps to prevent problems. I have had experience with the tape on the face method (not good for the patients skin) and using a one inch piece of tape folded over in order to make ties except for a small piece that is left unfolded to go around the ETT. I really like this method as it allows for felxibility in caring for the patients mouth and is an easy method to use.

It is a standard of care to rotate the ETT every 24 hours....this simple procedure helps to avoid the skin breakdown and increases patient comfort.

chex · May 15, 1999

Our standard practice was bite blocks until tube placement was ok'ed then tape for all.If someone was a biter then we usually went back to the bite block for hopefully only a day or two. Airways rarely worked pt's tongued them out. Tape was changed every day or two and the tube repositioned. As our RT's got busier tape changes became an issue. We then found holister tube holders. They are kind to the skin held on with duoderm and there is a track system on the top lip that the tube is attached to. This allows you to move the tube as often as you want. I do it each time I do mouth care and access to the mouth is great. The downside (there's always a downside)is that the track plus tube is heavy so you must move the tube several times a day especially on a person with teeth. And the breakdown is usually hidden on the underside of the lip. Usually this is only if the tube is kept predominately in the middle of the mouth.

Hope this helps. Good luck.