Endotracheal Tube Fixation Methods for Optimal Stability

Abstract

Accidental extubation of an intubated patient is a serious consideration in the surgical patient. Adequate fixation in the intubated patient is essential to prevent potentially life-threatening complications. Several methods of endotracheal tube fixation have been described in the literature. In this study, we examine 3 common methods of fixation: adhesive tape alone, suture, and tape-suture. Testing occurred in a laboratory setting with 2 fresh cadavers. Endotracheal tubes were inserted, using the methods of fixation in question. We subjected each fixation technique to progressively increasing weight to determine which technique is most resistant to accidental removal. We found that fixation of the tube by combining tape around the tube with a suture through the tape is the best noninvasive technique of the 3 methods evaluated in cases where movement of the head is anticipated.

Endotracheal tube fixation time: a comparison of three fixation methods in a military field scenario

“…In combat casualties, this is a common cause of preventable death on the battlefield 9. Movement of the ETT after successful intubation leading to accidental extubation or tube displacement are serious complications associated with high morbidity 2. Therefore, ETT should be quickly and effectively secured before any movement of the patient, especially in prehospital or combat settings.…”

“…The commonly used methods include adhesive tapes, non-adhesive tapes (twills), gauze bandage rolls and various commercially designed devices. Previous studies found that all these common techniques are acceptably stable 2–6. Although adhesive tapes have been shown to provide sufficient resistance to extubation, they are time consuming to apply, require significant preparation time and may be difficult to use in the prehospital, trauma and combat settings due to sweat, blood and dirt preventing appropriate adhesion 6.…”

The role of the endotracheal tube cuff in microaspiration

“…58 Overall, the data suggest that it is less expensive, more convenient, and just as effective to use standard white surgical tape to secure the ETT as any other alternative method. 54, 56 Unfortunately, none of these studies has examined the amount or effect of lateral and longitudinal movement of the ETT based on securement method.…”

An Innovative Method of Securing the Endotracheal Tube in Patients with Facial Hair Undergoing Neurosurgical Procedures

“…Accidental extubation can lead to catastrophic events, especially in head and neck surgeries, when airway access is difficult intraoperatively. 1 Providing anesthesia to the patients with facial hair or beard is always a challenge because, in addition to difficult mask ventilation, tube fixation is also tricky. Some people keep a beard because of religious beliefs, while others keep it as a symbol of fashion or respect, so they do not consent to shave.…”