Stabilisation of an Endotracheal Tube for the Adult Intensive Care ...

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Number Statement: Choice of Method Grade of recommendation 2 2a 2b 2c The methods for stabilising an ETT can be divided into 3 groups: twill tape; adhesive tape and manufactured devices. There is minimal research evidence to support the use of any one method over the other two. However, there are principles that can inform the choice of method for specific clinical situations The use of adhesive tape/devices should be avoided in patients with impaired facial skin integrity (eg burns, cellulitis). The use of adhesive tape/devices should be avoided in patients with extreme diaphoresis. The use of adhesive tape/devices should be avoided in patients in male patients with beards. 12 Consensus Opinion Consensus Opinion Consensus Opinion Consensus Opinion There are three main methods of achieving tube stabilisation: 1) tying the tube to the patient’s head using white cotton tape; 2) taping it to the patient’s face using medical adhesive tape; or 3) using a commercial tube holder. Gardner et al (2006) conducted a systematic review to establish what method of ETT stabilisation: 1) resulted in the least amount of tube displacement; 2) resulted in the least amount of unplanned or accidental extubations; 3) resulted in the least amount of facial skin, lip and/or oral mucosa breakdown; and 4) is preferred by nurses for the maintenance of oral hygiene. This review was hampered by the heterogeneity of design and quality of the seven studies included. In addition studies were dated and some of the commercial products not available in Australia. No evidence was found regarding outcomes related to tube displacement. One study (Tominaga, Rudzwick et al. 1995) found that medical adhesive tape significantly reduced the UEX rate over four study periods (15% during control, 4%, 2% and 6% in following periods). However non-equivalent study periods and treatment of patients especially with respect to sedation and pain relief as well as the probability of a significant Hawthorne effect limit the clinical application of these findings. By contrast a multicentre prospective observational study of UEX rates in French ICUs identified 46 UEX episodes in 426 patients over a two-month period (UEX rate = 10.8%). In this study endotracheal fixation with only thin adhesive tape, orotracheal intubation and the lack of intravenous sedation were three factors most common to UEX (Boulain 1998). However there was a limited description of
how these variables were defined leading to possible bias especially with respect to what ‘thin adhesive tape’ actually was. A limited meta-analysis by Gardner et al (2006) indicated that a commercial device might result in less lip excoriation (OR 0.22[0.10, 0.50, 95%CI]) and reduce the incidence of facial trauma (OR 0.40 [0.13, 1.22 95%CI]), however these commercial products are not available in Australia. The external validation panel (EVP) supported all of these recommendations. Number 3 Statement: Patients with risk of raised intracranial pressure Endotracheal tube securing methods that may cause venous occlusion should be avoided for patients at risk of raised intracranial pressure. 13 Grade of recommendation Consensus Opinion Most ETT stabilisation methods require the tapes or ties to go around the upper part of neck. There is however a theoretical risk that doing this may impair the venous drainage from the head with a possible impact on intracranial pressure. The tracheal tube practices survey [Appendix 3] identified five units who varied their practices for neurological or neurosurgical patients for this reason. Whilst no published research data was found to support this, the GDN members feel this is an important consideration for clinicians when choosing the most appropriate method of ETT stabilisation. The EVP endorsed this recommendation.
Page 1 and 2: Stabilisation of an Endotracheal Tu
Page 3 and 4: Index Abbreviations and Acronyms...
Page 5 and 6: Executive Summary Invasive ventilat
Page 7 and 8: Clinical Practice Guideline 1. Intr
Page 9 and 10: each recommendation statement using
Page 11: Number Statement: Clinician Governa
Page 15 and 16: The consequences of migration or mo
Page 17 and 18: Number Statement: General The venti
Page 19 and 20: What method of ETT stabilisation re
Page 21 and 22: External Validation Process In May
Page 23 and 24: Integrative Literature Review Intro
Page 26 and 27: 5. Summary Tables of Research Paper
Page 28 and 29: Appendix 1: Data Extraction Tools P
Page 30 and 31: Appendix 2: Survey of current NSW E
Page 32: References Alderson, P(2006) Guidel

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