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ET tube fixation methods

Narasimha Rao
Narasimha Rao
in Practical Procedures

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I’m trying to identify a good fool proof method of securing ET tube and there doesn’t seem to be a consensus.

 

I’d like to hear what methods do you all use on your units and if you could share any thoughts, experiences and ideas here please.

 

 

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I am reviewing our current methods and we have a choice between non-adhesive tape, neo-bar, neo-fix and the clip.

I wondered if there had been any local/ regional audits looking at safety (unplanned extubations), skin and tissue viability issues, MRI compatibility, infection control etc.

Appreciate all your inputs.


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24 minutes ago, NRao said:

Thanks Stefan. I’ve been considering this too.

I got the advice on this device some years ago from a US-based RT. It is very easy to adjust the tube position as the tube is secured with velcro over metal "nabs". Don't know if it MR-safe though (manufacturer would know).

For smaller preterms (like <1000g) the "tape plates" are too big. And care in high incubator humidity works less well, the tape gets loose. But overall and especially for term infants needing short-term invasive ventilation, this device works really well IMHO.

The Karolinska level-3 NICU use tape in a new fashion, I think there is a video clip on Vimeo - will check out next week at work if I can share it here :) 

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    I agree with Stefan. With size 2.5 ETTs, the Neofit plates are difficult to tighten "just right". They are often too loose and let the ETT slide, or, if tightened more, they can crimp the ETT and impede passage of a suction catheter. Otherwise, the device works fairly well. We have also tried Neobar, and used modified cord clamps for years. There is no evidence of a clear advantage of any particular system, and our experience doesn't point to a clearly superior method, either. We think we might have had less unplanned extubations with the locally modified cord clamps, but we didn't rigorously track unplanned extubation rates back then, so we really don't know.

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    The NICU`s in the Netherlands al secure tubes with tape. It only differs in detail and in the type of tape.

    At the last NICU congres in Copenhagen there was a poster from Sweden about the tape fixation.

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    We use Neobars. When the baby is in heat and humidity, they tend not to work as well. On occasions we some time add Tegaderms for additional support.

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    49 minutes ago, Stefan Johansson said:
    Dear all, Karolinska University Hospital has published their tube taping practise on Youtube. 
    @Karolinska and Anna Gudmundsdottir - thanks so much for sharing!
    Nasal tube fixation

     
     


    Thank you! With practice drifting towards resuscitating 22w onwards, I wonder what would be the choice of securing device? Given that we would be using size 2 ETT and NEO-FIT is not recommended.


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    • 2 weeks later...

    Hello all!

    I am a neonatologist, working at the Karolinska University Hospital in Stockholm.  We reviewed our ETT fixation strategies during 2017-2019 in a Quality Improvement Project.  We generally nasally intubate our infants, from week 22-term infants.  We looked at devices, and were especially interested in the NeoBAR, NeoFit and an attractive method used in England with a clip (can´t recall just now what it was called)  but all these were more suitable for oral ETT. After this ploughing of the market for devices and tapes, we decided that improving our taping technique with a new tape sort was the optimal choice.  In fact, it was a disappointment how few fixation methods/devices are available and how little interest the companies we contacted had in helping us. When we decided on our standardized taping method we focused on a "one fits all" method, as we have many co-workers that need to learn the method, furthermore we focused on "less tape is more" with the amount of tape.  Our standardized methods are shown in the links,  that Stefan already shared with you (see above).  We have followed our unplanned extubation rate which has decreased significantly after implementation and we also follow the rate of skin contusions/ulcerations due to taping. 

    It would be very interesting to here more thoughts on taping techniques and devices suitable, especially for nasla ETT.   Thank you for starting this chat and for letting us att Karolinska share our experiences. best regards Anna

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    I am based in South Africa. We tried both the Neobar and Neofit. The Neofit was the better option but agree with the comments above. Having tried both we felt tape was still the better option. We use a barrier film to protect the skin (if available) then extra thin hydrocolloid strips. We then use either zinc oxide or hypofix tape (5 strips) in much the same technique as described above.

    ETT strapping.PNG

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    • 3 weeks later...
    • 11 months later...

    @annag @Stefan Johansson Hi Anna and Stefan. I am doing a local QI project to reduced unplanned extubation in our unit and one of the things is to find a standardized way of securing the tube. I am keen to know what kind of 3M tape was used in the video? Thanks

    Thanks very much. I will keep you all updated if we find any new/creative ideas.

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    • 2 weeks later...

    Hi @Stefan Johansson

    I can't seem to source these in UK. Only coming up on 3m US website. Any idea how I can get them? Anyone else from UK who is using these can guide me please

    Thanks

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    Hi [mention=3]Stefan Johansson[/mention]
    I can't seem to source these in UK. Only coming up on 3m US website. Any idea how I can get them? Anyone else from UK who is using these can guide me please
    Thanks

    I couldn’t find it being marketed here in U.K.. Maybe worth contacting the representative?


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    • 4 weeks later...

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