Endotracheal tube, securing - Intensive Care & Coordination ...

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St Vincent’s Hospital Intensive Care Services Page 2 of 16 Securing an ETT: Intensive Care Clinical Practice Manual, Policy / Procedure R 4.1 4.0 DEFINITIONS An ETT is a breathing tube which is passed through a patient’s oro or naso -pharynx into the trachea in order to allow a patient to be ventilated. Intubation refers to the passage of the ETT into the trachea. Extubation is the removal of the ETT from the patient’s trachea. 5.0 INDICATIONS All patients who have an ETT must have it safely and appropriately secured. The standard way of securing ETTs at St Vincent’s ICU is to use trachy tape as described in Section 7.1 and 7.2. The technique using brown leukoplast tape is indicated for patients who should avoid having tape tied around the back of their neck. This includes patients who have had neurosurgical procedures and major head and neck surgery. In these situations the tape may cause venous congestion of the brain or impair the perfusion of free grafts by pressure on the arterial supply or venous drainage. The technique using the Oral Endotracheal Tube Attachment Device (E-TAD) is indicated for adult patients requiring longer term intubation (eg greater than 3 days). It is NOT appropriate for patients who: • Don’t have teeth or are unable to wear upper dentures • have full lips, facial swelling or protruding teeth • have moustaches or full beards. This technique is described in Section 7.5 and 7.6. 6.0 PRINCIPLES Appropriately and safely securing an ETT lessens the risk of accidental or self extubation. It also prevents migration of the tube to an unsafe and potentially harmful position either upwards into the larynx or downwards into the right main bronchus. Securing an ETT will be carried out utilizing the following practice principles: • Aseptic technique • Patient comfort and safety • Anatomy and physiology • Body substance isolation Securing an ETT Policy / Procedure R 4.1 Page 2 of 16 ICU Clinical Practice Manual Implemented July 2006, Review July 2009.
St Vincent’s Hospital Intensive Care Services Page 3 of 16 Securing an ETT: Intensive Care Clinical Practice Manual, Policy / Procedure R 4.1 6.1 Principles of Risk Management. The following risk management principles shall also be applied in reference to the securing of ETTs: • Once a tube is in place it must be secured so that it cannot fall out and so that it cannot migrate upwards or downwards. • Re-tying of the ETT should be done as infrequently as possible and never as a routine. • Securing an ETT is a two person procedure. At no time must a tube be left unsecured. The ETT must be secured by hand by a dedicated nurse or doctor when the tube is being tied or re-tied. • If it is necessary to re-secure an ETT, this procedure ideally should be carried out when staff are fresh and alert (eg not at the end of a tiring shift) and a medical officer is available should a tube become accidentally dislodged and emergency re-intubation becomes necessary. • Once a tube is placed, clinical examination should confirm that there is equal air entry. • The chest Xray should be viewed to confirm the tip of the ETT is just above a line half way through the aortic knob ( or 2 cms above the carina). • Once the correct position has been established the tube should be cut at 2.5 cm from the lips to prevent potentially fatal migration. • One of the following written protocols must be used to secure the ETT. Securing an ETT Policy / Procedure R 4.1 Page 3 of 16 ICU Clinical Practice Manual Implemented July 2006, Review July 2009.
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