What is the "tension to ET tube" in NICU setting

Emm_RN, ASN, BSN, MSN · Jun 25, 2019

Hi, they are saying to essentially keep tension by pulling away from the babies. This is what needs to be done when the ET tube may be sitting just a bit too deep and may be positional, so by pulling a little bit of tension, the ET tube is sitting up high enough to be in correct placement. We used to do this by using the ET tube holders and turning them just a bit so that the ET tube didn't have much play. Hope this helps!

Coffee Nurse, BSN, RN · Jun 26, 2019

Agree with Emm_RN, tension/traction means pulling the ETT away from the baby just a bit. Be careful especially if you use tape to secure, as this can accelerate the loosening process and cause you to have to retape sooner. Also, I can't emphasize strongly enough the importance of clarifying if you don't understand what someone tells you, rather than waiting and asking strangers on the Internet. We don't know exactly what that person had in mind, terminology differs between facilities and regions, and by the time you get an answer here, the baby may have had a negative outcome. Don't worry about how you think it might make you look to your coworker. ASK.

adventure_rn, MSN, NP · Jul 2, 2019

Agree with the above. The main time I ever get feedback to put tension on an ETT is when you're holding for an x-ray to ensure that the tube is actually in the correct position so it won't look falsely deep on x-ray, or if the last x-ray showed the tube was too deep and you're making sure the kid doesn't constantly vagal/brady while you wait to retape.

I would still check in with your RT before fussing around with the tube; with the micros, put too much tension on the tube and you'll accidentally extubate. There's only a tiny fraction of a cm between too deep, not deep enough, and accidental extubation.

**NICU Guy, BSN, RN** · Jul 3, 2019

16 hours ago, adventure_rn said:
I would still check in with your RT before fussing around with the tube; with the micros, put too much tension on the tube and you'll accidentally extubate. There's only a tiny fraction of a cm between too deep, not deep enough, and accidental extubation.

This happened to me last week. Transferring a micro preemie to mom for Kangaroo Care, I was on the body and another nurse was managing the tube during the transfer. We got the baby transferred and attempted to secure the ventilator tubing to mom when he started to brady and desat. We tested the airway with an inline CO2 detector and got no color change. Both of us were vigilant on ensuring that that the tube didn't move and it still happened.

adventure_rn, MSN, NP · Jul 3, 2019

12 minutes ago, NICU Guy said:
This happened to me last week. Transferring a micro preemie to mom for Kangaroo Care, I was on the body and another nurse was managing the tube during the transfer. We got the baby transferred and attempted to secure the ventilator tubing to mom when he started to brady and desat. We tested the airway with an inline CO2 detector and got no color change. Both of us were vigilant on ensuring that that the tube didn't move and it still happened.

Ugh, nightmare fuel. It sounds like you guys knew exactly how to handle it though. Kangaroo transfers on intubated patients always make me nervous.

I remember a kid who I was caring for; the RT had gotten in report (and from the x-rays) that the tube had continued to look too deep, so they were putting a ton of tension on it. It turned out that the baby hadn't been properly positioned during x-ray, so the tube was actually higher than they'd realized. After our routine x-ray, I got a call from the NNP who literally said, "Um, how are your sats, because I think your baby is extubated." I remember saying, "We're satting 95, so I'm pretty sure the tube is still in...?" The exchange was followed by a frantic tube retaping. That encounter had a happy ending, but it's always made me extra cautious about putting tension on the tube.

It also depends on how your tube is secured. Like Coffee Nurse said, if your tube is literally secured with tape, tension can cause the tape to loosen prematurely. If your tube is secured with a securing device (i.e. a plastic piece that has little plastic clamps/teeth to grip the tube), tension can cause the tube to literally start to slide out of position. We used a securing device in my story above, and I think that over time, all of the tension on the tube actually caused it to slide out even farther than it was supposed to be. As NICU Guy said, you have to be diligent about knowing how deep your tube is supposed to be, and making sure it stays put.

vintage_RN, BSN, RN · Jul 27, 2019

Yikes! This is something I’ve never heard of and definitely not something we do in our NICU. Actually all intubated patients are a 2 person RT/RN handle due to having many unplanned extubations.

Wuzzie · Jul 27, 2019

IMHO tension to the tube should only be a temporary measure until it can be re-secured at the correct depth.