Endotracheal tube, securing - Intensive Care & Coordination ...
Endotracheal tube, securing - Intensive Care & Coordination ...
Endotracheal tube, securing - Intensive Care & Coordination ...
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St Vincent’s Hospital <strong>Intensive</strong> <strong>Care</strong> Services Page 3 of 16<br />
Securing an ETT: <strong>Intensive</strong> <strong>Care</strong> Clinical Practice Manual, Policy / Procedure R 4.1<br />
6.1 Principles of Risk Management.<br />
The following risk management principles shall also be applied in reference to<br />
the <strong>securing</strong> of ETTs:<br />
• Once a <strong>tube</strong> is in place it must be secured so that it cannot fall out and<br />
so that it cannot migrate upwards or downwards.<br />
• Re-tying of the ETT should be done as infrequently as possible and<br />
never as a routine.<br />
• Securing an ETT is a two person procedure. At no time must a <strong>tube</strong> be<br />
left unsecured. The ETT must be secured by hand by a dedicated<br />
nurse or doctor when the <strong>tube</strong> is being tied or re-tied.<br />
• If it is necessary to re-secure an ETT, this procedure ideally should be<br />
carried out when staff are fresh and alert (eg not at the end of a tiring<br />
shift) and a medical officer is available should a <strong>tube</strong> become<br />
accidentally dislodged and emergency re-intubation becomes<br />
necessary.<br />
• Once a <strong>tube</strong> is placed, clinical examination should confirm that there<br />
is equal air entry.<br />
• The chest Xray should be viewed to confirm the tip of the ETT is just<br />
above a line half way through the aortic knob ( or 2 cms above the<br />
carina).<br />
• Once the correct position has been established the <strong>tube</strong> should be cut<br />
at 2.5 cm from the lips to prevent potentially fatal migration.<br />
• One of the following written protocols must be used to secure the<br />
ETT.<br />
Securing an ETT Policy / Procedure R 4.1 Page 3 of 16<br />
ICU Clinical Practice Manual Implemented July 2006, Review July 2009.