Two Different Endotracheal Tube Securing Techniques: Fixing Bandage vs. Adhesive Tape
Introduction: Emergency physicians should secure Endotracheal tubes (ETT) properly in order to prevent unplanned extubation (UE) and its complications. Despite various available endotracheal tube holders, using bandages or tape are still the most common methods used in this regards. Objective: This study aimed to compare adhesive tape (AT) versus fixing bandage (FB) method in terms of properly securing ETT. Methods: This was an observational longitudinal trial. All patients older than 15-years-old admitted to the ED who had indication for ETT insertion were eligible. Patients were randomly assigned to one of the two groups in which AT or FB was applied. All patients were observed thoroughly in the first 24 hours after intubation. Using a pre-prepared checklist, encountered UE rate and other data were recorded. Results: Seventy-two patients with the mean age of 55.98 ± 18.39 years were finally evaluated of which 38 cases (52.8%) were male. In total, 12% of patients in our study experienced unplanned extubation. Less than 12% of the patients experienced complete UE; there was no statistically significant difference between the two groups (p = 0.24). Comparison of UE with age showed no significant difference (p = 0.89). Male patients experienced more UE, but this was not statistically significant (p = 0.44). Conclusion: It is likely that whether the AT method or FB was applied for securing the ETT in emergency departments, there was no significant difference in rates of unplanned extubation.
2. Barnason S, Graham J, Wild MC, Jensen LB, Rasmussen D, Schulz P, et al. Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity. Heart Lung. 1998;27(6):409-17.
3. Seyedhosseini J, Talebian M, Ghafari M, Eslami V. Secondary confirmation of endotracheal tube position by diaphragm motion in right subcostal ultrasound view. Int J Crit Illn Inj Sci. 2013;3(2):113-7.
4. Saeedi M, Hajiseyedjavadi H, Seyedhosseini J, Eslami V, Sheikhmotaharvahedi H. Comparison of endotracheal intubation, combitube, and laryngeal mask airway between inexperienced and experienced emergency medical staff: A manikin study. Int J Crit Illn Inj Sci. 2014;4(4):303-8.
5. da Silva PS, Fonseca MC. Unplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations. Anesth Analg. 2012;114(5):1003-14.
6. Kapadia F. Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med. 2001;163(7):1755-6.
7. Hossein-Nejad H, Payandemehr P, Bashiri S, Nedai H. Chest radiography after endotracheal tube placement: is it necessary or not? Am J Emerg Med. 2013;31(8):1181-2.
8. S R. Basic airway management. In: W R, editor. Manual of emergency airway management. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 43-57.
9. Boulain T. Unplanned extubations in the adult intensive care unit: a prospective multicenter study. Association des Reanimateurs du Centre-Ouest. Am J Respir Crit Care Med. 1998;157(4 Pt 1):1131-7.
10. Kabrhel C, Thomsen TW, Setnik GS, Walls RM. Videos in clinical medicine. Orotracheal intubation. N Engl J med. 2007;356(17):e15.
11. K L. Comprehensive respiratory nursing. Philadelphia: WB Saunders; 1989.
12. Dunleap E. Safe and easy ways to secure breathing tubes. RN. 1987;50:26-7.
13. Carlson J, Mayrose J, Krause R, Jehle D. Extubation force: tape versus endotracheal tube holders. Ann Emerg Med. 2007;50(6):686-91.
14. Levy H, Griego L. A comparative study of oral endotracheal tube securing methods. Chest. 1993;104(5):1537-40.
15. RM W. Rapid sequence intubation. In: RM W, editor. Manual of emergency airway management. 1. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 8-15.
16. Idem. Confirmation of endotracheal tube placement. In: RM W, editor. Manual of emergency airway management. 1. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 27-30.
17. Lutes M HL. Tracheal intubation. In: Roberts JR HJ, editor. Clinical procedures in emergency medicine. Philadelphia: Saunders; 2004. p. 69-99.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.