Tape on the ET tube tearing skin

[canesdukegirl]

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?

[mentalhealthRN]

I apply "skin-prep" before putting anything adhesive anywhere on the body of my older patients. Especially when they have what I call that "onion skin". I find I get almost no skin tears this way. I am guessing they are a product used everywhere. They prep the skin and create a sort of sticky film so that the adhesive sticks to the thin film and not the actual skin. I love that stuff. They are individually packed like an alcohol prep. And what ever you are trying to have stick will stay better too. Just a thought. --and it makes the taking off later a lot less painful for the patient. Hope it works.

[FlyingScot, RN]

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 SkinIt is made for delicate skin, but it holds the ET tube well for anesthetic cases.

Bolding is mine. Just in case people are thinking this will work in other applications please be aware that long term the Hy-Tape loses its adhesion to the ETT. We trialed it and had multiple extubations where the tape was secure to the face but the tube had slid out (sometimes completely, leaving a perfectly round opening where it had originally been). At the time the manufacturer recommended that we suture the tape to the tube which we found ridiculous. Now this has been some years back so they may have changed the adhesive to fix the problem. I do like Hy-tape though...just not for ETTs long term.

[canesdukegirl, BSN, RN]

I apply "skin-prep" before putting anything adhesive anywhere on the body of my older patients. Especially when they have what I call that "onion skin". I find I get almost no skin tears this way. I am guessing they are a product used everywhere. They prep the skin and create a sort of sticky film so that the adhesive sticks to the thin film and not the actual skin. I love that stuff. They are individually packed like an alcohol prep. And what ever you are trying to have stick will stay better too. Just a thought. --and it makes the taking off later a lot less painful for the patient. Hope it works.

You aren't talking about Mastisol, are you?

[ebear, BSN, RN]

"suture the tape to the tube"??? more mental giants....BWAAA!!!!!!!!!!!!!! :eek:

[canesdukegirl, BSN, RN]

"suture the tape to the tube"??? more mental giants....BWAAA!!!!!!!!!!!!!! :eek:

"Would you like 2-0 or 3-0 Nylon?"

[mentalhealthRN]

Smith & Nephew - Skin-Prep*

Here is the site address to one of the products I have used often and like a lot--use them for everything from wound VAC application, decub dressings, anywhere really that you need to put adhesive. Not sure what they are actually made of....never really looked to be honest! LOL

[ebear, BSN, RN]

I think 2-0 monofilament..... better still, how 'bout #2 Prolene?? :rotfl:

[wtbcrna, MSN, DNP, CRNA]

Bolding is mine. Just in case people are thinking this will work in other applications please be aware that long term the Hy-Tape loses its adhesion to the ETT. We trialed it and had multiple extubations where the tape was secure to the face but the tube had slid out (sometimes completely, leaving a perfectly round opening where it had originally been). At the time the manufacturer recommended that we suture the tape to the tube which we found ridiculous. Now this has been some years back so they may have changed the adhesive to fix the problem. I do like Hy-tape though...just not for ETTs long term.

You are absolutely right hy-tape will not hold long term. The ICU where I am at uses an ETT holder that is attached to duoderm which is the only part that touches/sticks to the skin.

[tyvin, BSN, RN]

This is for O2 tubing for the crepe paper skin/fragile skin; before you put on the tubing; wrap the part of the tubing that will touch the front of the face with a 4x4 or part of one so the tubing doesn't sink into the skin. It's also helpful to put the rolled gauze on the ears or you can wrap the tubing with 4x4's so the tubing doesn't touch the skin. I've never seen a concern with the neck area as it is mostly the face and ears that are compromised from the O2 tubing, but that doesn't mean it doesn't happen.

[ZippyGBR, BSN, RN]

what happened to tying the the ET with a proper ET tube tape or a 2in conforming bandage ?

[wtbcrna, MSN, DNP, CRNA]

what happened to tying the the ET with a proper ET tube tape or a 2in conforming bandage ?

I have only seen one anesthesia provider that tied his ETT. He did it for the very reason the OP mentioned, but I have never had trouble with the HY-tape.