Stabilisation of an Endotracheal Tube for the Adult Intensive Care ...
Stabilisation of an Endotracheal Tube for the Adult Intensive Care ...
Stabilisation of an Endotracheal Tube for the Adult Intensive Care ...
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written guideline <strong>for</strong> this procedure <strong>an</strong>d only nine <strong>of</strong> <strong>the</strong>se protocols were less th<strong>an</strong> two<br />
years old.<br />
The recommendations in this guideline were in<strong>for</strong>med by <strong>an</strong> integrative literature review<br />
covering <strong>the</strong> publication years <strong>of</strong> 1980-2006 [See Integrative literature review] <strong>an</strong>d <strong>the</strong><br />
clinical experience <strong>of</strong> <strong>the</strong> guideline development network members who were senior<br />
clinici<strong>an</strong>s from NSW ICUs. Due to <strong>the</strong> lack <strong>of</strong> <strong>an</strong>y evidence <strong>the</strong>se recommendations were<br />
considered to be <strong>the</strong> key guiding principles that a protocol writer should incorporate into<br />
whatever method/s <strong>of</strong> ETT stabilisation are most appropriate <strong>for</strong> <strong>the</strong>ir patient mix <strong>an</strong>d clinical<br />
setting.<br />
2. Scope<br />
The recommendations in this guideline are focussed on <strong>the</strong> clinical practices used to<br />
maintain <strong>the</strong> optimal position <strong>of</strong> <strong>an</strong> endotracheal tube that is inserted into <strong>an</strong> adult in <strong>an</strong><br />
intensive care unit referred to as ‘stabilisation <strong>of</strong> <strong>an</strong> endotracheal tube’. The following issues,<br />
although considered import<strong>an</strong>t, are beyond <strong>the</strong> scope <strong>of</strong> this guideline:<br />
• Issues related to patient autonomy such as patient consent <strong>an</strong>d expl<strong>an</strong>ation <strong>of</strong><br />
procedure.<br />
• Documentation <strong>of</strong> patient assessment <strong>an</strong>d outcomes <strong>of</strong> nursing procedures.<br />
3. Purpose<br />
This guideline has been developed to provide intensive care clinici<strong>an</strong>s with recommendations<br />
or principles to guide <strong>the</strong> development <strong>of</strong> local policy/procedure related to stabilisation <strong>of</strong> <strong>an</strong><br />
endotracheal tube. The guideline does not address <strong>the</strong> minutiae <strong>of</strong> this practice.<br />
4. Target Clinici<strong>an</strong>s<br />
The target clinici<strong>an</strong>s are registered nurses <strong>an</strong>d medical <strong>of</strong>ficers working in NSW ICUs. This<br />
includes both beginner <strong>an</strong>d experienced clinici<strong>an</strong>s <strong>an</strong>d assumes knowledge <strong>of</strong>: <strong>an</strong>atomy <strong>an</strong>d<br />
physiology <strong>of</strong> <strong>the</strong> head <strong>an</strong>d neck; <strong>the</strong> purpose <strong>of</strong> <strong>an</strong> ETT <strong>an</strong>d import<strong>an</strong>ce <strong>of</strong> mainten<strong>an</strong>ce <strong>of</strong><br />
correct position; possible sequelae associated with <strong>the</strong> different stabilisation methods; <strong>an</strong>d<br />
<strong>the</strong> consequences <strong>of</strong> unpl<strong>an</strong>ned extubation.<br />
5. How <strong>the</strong> guideline was developed<br />
This guideline was developed by <strong>the</strong> ETT guideline development network (GDN) comprised<br />
<strong>of</strong> six senior nursing clinici<strong>an</strong>s <strong>an</strong>d three nursing academics, within <strong>the</strong> ICCMU <strong>Intensive</strong> <strong>Care</strong><br />
Collaborative project. The recommendations were developed during round table discussions<br />
at ICC-CDC held on December 1 2006. Consensus was achieved by a postal round whereby<br />
a consensus <strong>for</strong>m was sent to GDN members who assigned <strong>the</strong>ir level <strong>of</strong> agreement with<br />
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