Tube securing devices

USES

  • prevent dislodgement of endotracheal or tracheostomy tubes

DESCRIPTION

  • 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)

METHOD OF INSERTION/ USE

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

COMPLICATIONS

  • 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)

OTHER INFORMATION

  • 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

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

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

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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