Tape on the ET tube tearing skin

ittybabyRN, RN · Nov 7, 2010

I work in nicu and some of those supposed to still be fetuses have the same type of skin. We use replicare as a barrier under the tape and a special adhesive remover that unsticks the tape from skin to get it off w/o tears

PetiteOpRN · Nov 7, 2010

We use paper tape for patients with skin that tears easily, or tie the ET tube instead of taping it (not sure what the ties are, it's like umbilical tape but thicker). We also tegaderm or the blue superman goggles over the eyes instead of tape.

We usually dress tears with mepilex or duoderm.

GHGoonette, BSN, RN · Nov 7, 2010

If he had haematomas from the pressure of the mask, he must have a very delicate skin indeed! I have never seen what you describe, even with the old black masks; the new ones are so soft they'd have to be pushed onto the patient's face with really excessive force to cause that kind of damage.

Tegaderm 1626 is fairly popular with our anaesthetists for reinforced tubes, but normally we just use Transpore. I'm guessing that it wouldn't make much difference what you use with such paper-thin skin; unless you loosen it with some alcohol prior to removing it, you'll still have a problem.

One of the older anaesthetists has an anchoring method using a Kling bandage. He cuts a piece, about 1.5 metres, wraps the centre around the tube and then passes it around the patients neck, but I can't remember the exact technique or how he fastens it. Maybe one of your local guys knows how to do it; if I see this old chap, I'll ask him to show me, but we don't see him all that often. He usually stands in for one of the others when they're on holiday.

sunnycalifRN · Nov 7, 2010

I've seen it happen before with COPD'ers with "steroid skin" . . . best thing to do, if you see any indication of that happening, like with tape on the arms causing skin removal, is to have RT switch to the velcro type of holder, if they have them . . . you put a small piece of the "hook" side of velcro on the tube, and the "snag" side of the velcro is the around the neck piece. Works great, and when the long piece gets soaked with oral secretions, they can just swap it out.

canesdukegirl, BSN, RN · Nov 7, 2010

Thanks for the suggestions, y'all. I think I will employ the velcro holders. Christine, I have never seen this happen before either. I felt so badly for this poor man. I once saw a surgeon wrap Coban around a stockinette when draping for a total knee replacement and when he unwrapped the Coban, the skin came off with it. Yikes!

FlyingScot, RN · Nov 7, 2010

I've used extra thin Duoderm under the tape as a skin barrier. I hate those ETT holders. They make it hard to do oral care.

ebear, BSN, RN · Nov 7, 2010

Our anesthetists use the 1/2" pink plastic tape. I've never seen any problems with this type. FWIW, the "hypoallergenic" transpore tape takes my skin off (entire layer) in 15"flat. And I'm not elderly...yet! It's strange about the hematomas. :confused: Was d-dimer done?

allnurses Guide · Nov 7, 2010

Hy-tape is what most anesthesia departments use to secure their ET tubes that I have worked at. Hytape International, Inc. - Applications - Securing Devices / Delicate Skin

It is made for delicate skin, but it holds the ET tube well for anesthetic cases. Before you decide what needs to be done to hold an ETT in place I would suggest eliciting some suggestions from your anesthesia providers. You can buy all the securing devices you want, but if the anesthesia providers refuse to use them it is nothing but a waste of time and money on your part. We kinda tend to have our own opinions on what needs to be done with our ET tubes.....Just my two cents for what it is worth.

ebear, BSN, RN · Nov 7, 2010

Thanks,wtbcrna! I couldn't remember the "official" name of it.:)

BabyLady, BSN, RN · Nov 7, 2010

I was recently doing a procedure on an elderly man with crepe paper skin. The anesthesia provider taped the ET tube to the face the way we always do. Upon preparing for extubation, the CRNA removed the tape, and this poor man's skin came off with the tape. He had a huge hematoma under the tear and the surgeon had to dermabond the tear. He also had hematomas on both sides of his mandible where the O2 mask was. I did not see this CRNA apply undue pressure to the mask, and he was not rough in removing the tape. The patient had a normal PT/PTT and INR and had stopped taking any blood thinners 10 days prior to surgery.
I felt so badly for this pt, and I can not for the life of me figure out why this happened. Has anyone else had this same experience with tape? We used regular silk tape. I was thinking about asking the anesthesia department to start using the ET holders on elderly patients as a general rule. Have any of you used these holders?

I guess I don't understand why patients that have obviously fragile skin, why soomeone doesn't get adhesive remover and remove the tape that way.

The CRNA has no one to blame but himself and if I was the family member, I would have complained.

No reason for that to happen.

BabyLady, BSN, RN · Nov 7, 2010

We use paper tape for patients with skin that tears easily, or tie the ET tube instead of taping it (not sure what the ties are, it's like umbilical tape but thicker). We also tegaderm or the blue superman goggles over the eyes instead of tape.
We usually dress tears with mepilex or duoderm.

Paper tape doesn't work on everyone...it actually rips my skin off...from my forearm, of all places and I do not have fragile skin.

So I never assume how the tape will come off, I always take it off slowly or else I get adhesive remover.