Tube securing devices


  • prevent dislodgement of endotracheal or tracheostomy tubes


  • Many different techniques and devices
  • Linen tape tied around the head and to the tubes — cow’s hitch enables tape gripping the tube over the widest possible area, thereby reducing the potential for slippage and displacement.
  • Adhesive cloth tape (e.g. cut into ‘trousers’ and applied to the patients face above the lip and around the tube (may be facilitated by using skin preparation materials such as 3MTM Cavilon that increase the adherence and protect the tissues)
  • Commercial products – neck ties with Velcro straps; adhesive holders (e.g. Hollister ETAD – Endotracheal Attachment Device)


  • Varies with technique
  • Must ensure that excessive movement of the tube is prevented


  • Pressure ulceration and skin necrosis (under the tube or securing devices)
  • excessive tube movement (loss of adherence or tying too loosely) with accidental extubation or endobronchial entry with lung collapse or barotraumas
  • inability to quickly remove a tube (e.g. if displaced above the cords and needs urgent replacement)


  • Choice of device depends on resources available, unit preference and patient factors (e.g. avoiding pressure on the neck from tapes by using a Hollister ETAD may be beneficial in neurosurgical patients with raised intracranial pressure)
  • alveolar ridge screws may be used to tie the tube to in patients with facial burns
  • No evidence that any type of knot is better than any other for tube ties

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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