Endotracheal intubation is a common lifesaving procedure. ETT placement can occur in operating rooms, intensive care units (ICUs), or emergency departments. It is important to ensure ETTs are properly secured to prevent displacement.1
ETT dislodgment can lead to potentially life-threatening complications such as accidental extubation or mainstem intubation. Unplanned extubation is commonly seen in adult and pediatric ICUs, with higher rates reported in pediatric ICUs. ETT stabilization can help prevent these complications.1
Methods of ETT stabilization include1:
- Purpose-built commercial devices
A study conducted by Gamble, et al. investigated which commonly used tape/supplementary adhesive methods provided the greatest resistance to ETT distraction. Data was collected at the Saskatoon Healthy Authority facilities from June to August of 2015, 2016, and 2019.1
24 different types of ETT securing methods were tested (6 types of tape alone and in combination with 1 of 3 supplementary adhesives). The primary measurement was the peak force (Newtons) required to distract a secured ETT 3 cm over 1 minute. The 3 cm distraction parameter was used to represent the approximate distance required to extubate a child intubated with a 4.5-mm inner diameter ETT (~ 2 years old) if the ETT tip was initially in the mid-tracheal position (expected tracheal length of ~ 6 cm).1
A total of 1,164 measurements were taken. The mean force required for ETT distraction ranged from 7.8 to 21.8 Newtons, with significant differences noted in the amount of force needed to distract an ETT depending on the type of securement method used.1
Graph created with data from Gamble JJ, McKay WP, Peeling A, et al. A comparison of
methods used to secure pediatric endotracheal tubes using a live human dermal model.
Can J Anesth (2021). 68:645-652. https://doi.org/10.1007/s12630-020-01904-0
Gamble JJ, McKay WP, Peeling A, et al. A comparison of methods used to secure pediatric
endotracheal tubes using a live human dermal model. Can J Anesth (2021). 68:645-652.