Procedure Manual
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Comment on this procedure
STANDARDS:
* All registered nurses and medical officers may secure and care for endotracheal tubes. Two people are required for this procedure.
* The endotracheal tube will be secured in such a way as to maintain its desired position.
* The cuff pressure of an endotracheal tube will be checked once a shift and prn.
* The endotracheal tube will be secured in such a way as to prevent pressure sores from developing.
* The endotracheal tube will be secured so as not to occlude the pilot tube.
OUTCOMES:
* The patient will not develop problems with pressure sores from securing an ETT.
* The ETT will not become malpositioned.
EQUIPMENT: 1.5m length of _ inch cotton tape
Acetone
Friars balsam
Large cotton applicators
Leucoplast tape - 1 inch
PROCEDURE:
* Once the ETT is placed in the patient and position is checked by auscultation the ETT is tied in using white cotton tape.
R : 19.1
* The tape is doubled and the loop end placed near the ETT. The two ends of the tape are then passed around tube and through the loop forming an initial knot that is tied firmly. A reef knot is then tied over this.
* The ends of the tape are then passed around the patients neck and tied at the side of the neck using a reef knot.
* The tape should be tight enough to prevent migration of the tube but must allow one finger to be placed under it at any point.
* A chest x-ray should be attended to check on position of ETT and the distance of the tube at the patients lips.
* Leucoplast tape is then prepared for more permanent tube security by cutting two pieces approx. 20cm long and cutting each to form trouser leg shape with legs approx. 12cm long.
* One operator secures tube by hand whilst the other removes white cotton tape.
* The cheeks are cleaned with acetone, shaved if necessary and then painted with friars balsam except if allergy noted.
* The leucoplast is applied so as main body of tape sits on cheeks and the bifurcation sits at the corner of the mouth. One leg of each tape is secured around tube and one leg is taped to either the top or bottom of each lip.
* The tube is to be anchored to both top and bottom lips to ensure good security.
* An additional piece of tape can be placed over the tape and under the lower lip to give added security.
POST PROCEDURE:
Note tube distance at patients lips on the patients flow chart.
Reviewed December 1995
R : 19.2
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