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Discussion

Securing ET's

I am just wondering what everyone is using for keeping their ET tubes secure, especially with infants. We are still using white sticky tape, with benzoine under the tape to keep secure. As we know with RSV secretions, it still gets extremely loose, and spending more time re-taping ET tubes.

So just curious if others are utilizing devices out there, and if one is better than another?

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    Tape. We usually put a layer of Duoderm ExtraThin underneath it. No benzoin... we use Mastisol. It goes underneath and on top of the Duoderm and part way up the ETT, then the tape goes on top of it. But then 99.9% of our ETTs are nasal...

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    Oooohhhhh........janfrn- I WISH I could convince our intensivists to nasally intubate. It is so much easier to work with AND your babies can still suck for comfort.

    Anyhoo.....we use tape. Masitsol and cloth tape. No holders EXCEPT for the occasional adult-sized patient.

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    meanmaryjean, nasal intubation does increase the risk of VAP quite significantly. But all of our intubating physicians prefer the nasal route, so all residents are required to learn the technique. As for commercial holders, we might occasionally see them in older patients who have been tubed elsewhere, but our RTs will take them off and replace them with tape at the first opportunity. Makes extubation of older males a real good time!

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    Why aren't tube holders widely used? Is it a cost issue?

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    No, not at all. It comes down to the core group of intensivists not liking or trusting tube holders... and what's being taught to new RTs when they join the peds units. Our adult ICUs use tube holders and have no issue with them.

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    The holders we have don't stick well! Of course when you have to take low bid...anywho, we and our PICU use benzoin and white cloth tape. Even in NICU we get those bigger kids who slob up the tape and have to be retaped frequently.

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    Part of our VAP protocol is for oral intubation. Obviously if there was a specific surgery or difficult intubation and it ended up being nasal, that's different.

    Not sure what that brown stretchy tape is but that's what our RTs use along with mastisol. That white tape does lose it's stick pretty easily. We retape if we get a kid from OR or outside facility with that stuff.

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    • Experts

    Our VAP protocol very deliberately avoids mention of tube route. We're all about the 45° HOB elevation and the "tubing draining away from the patient", as one of our intensivists reiterates at the end of his review of rounds as part of his QI mantra. Not that I disagree with those measures, but I really fell that if we're going to use bundles we shouldn't be picking and choosing the parts of the bundles we follow. Between nursing these kids sitting up, turning and cleaning out their mouths q2h and the noise around them 24/7 we have to use a barrel of sedation to keep them intubated.

    That Elastoplast tape is AWFUL for taping ETTs. It stretches and stretches then the tube trombones, the kid coughs and gags like nobody's business and we end up changing it.

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