Best method of taping endotracheal tube?

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MedicinePowder

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I can't seem to find any websites or book with strategies on taping the ETT. Where I'm at, they start taping on one cheek, run it across over the upper lip, then give it a few spins on the tube, then across to the other cheek. Somehow, that just doesn't look too secure. Any other strategies? Any websites with PICTURES depicting this?

thanx
 
it's funny how everyone will do it just a little differently. Some people will swab the cheeks with benzoate and then overlap tegaderms onto the tape and the skin with benzoate. makes me wonder if they had an accidental extubation disaster.
 
MedicinePowder said:
I can't seem to find any websites or book with strategies on taping the ETT. Where I'm at, they start taping on one cheek, run it across over the upper lip, then give it a few spins on the tube, then across to the other cheek. Somehow, that just doesn't look too secure. Any other strategies? Any websites with PICTURES depicting this?

thanx
Click to expand...

PLenty secure. I know this is a big deal when you're a resident, and its kinda scary, but after a while, at least for most cases, you figure out you're in the business of rendering people motionless-and once you are set up, nothing moves unless you move it.
If the case doesnt involve the face/neck or the patient isnt prone, any reasonable tape job will be sufficient.
Its funny though-everybody has their pet peeves about taping. I think for most cases you could use scotch-tape and be ok.
 
jetproppilot said:
PLenty secure. I know this is a big deal when you're a resident, and its kinda scary, but after a while, at least for most cases, you figure out you're in the business of rendering people motionless-and once you are set up, nothing moves unless you move it.
If the case doesnt involve the face/neck or the patient isnt prone, any reasonable tape job will be sufficient.
Its funny though-everybody has their pet peeves about taping. I think for most cases you could use scotch-tape and be ok.
Click to expand...

thanx for all the input; however, as a fourth year medical student i've already seen three IVs pulled out as they repositioned just prior surgery. each time the patient was intubated and though rare, i would want to secure the ETT tube as secure as possible in the one in ten thousand chance it may accidently get a 'good' tug.
 
MedicinePowder said:
thanx for all the input; however, as a fourth year medical student i've already seen three IVs pulled out as they repositioned just prior surgery. each time the patient was intubated and though rare, i would want to secure the ETT tube as secure as possible in the one in ten thousand chance it may accidently get a 'good' tug.
Click to expand...
If you're repositioning (into prone for example), it's not a bad idea to disconnect the tubing so it doesn't snag on something.

I had one attending tell me "Make sure you ALWAYS tape it this way", so the next day with another attending I did it and the new attending said, "NO! You NEVER tape it that way...do it this way!" So while you're a resident, the answer is "however your attending likes it."
 
MedicinePowder said:
thanx for all the input; however, as a fourth year medical student i've already seen three IVs pulled out as they repositioned just prior surgery. each time the patient was intubated and though rare, i would want to secure the ETT tube as secure as possible in the one in ten thousand chance it may accidently get a 'good' tug.
Click to expand...

I too have seen and heard slightly conflicting things about taping, but it seems that as long as I get the ETT in, confirmed, and secured methodically and relatively quickly, my faculty are cool with it. One guy insists that the tape be wound around the ETT pretty close to the lips, which is about what I do anyway.

Last week I helped with a case that was going to be transfered to the MRI room where the patient would be inaccessible for periods of time. You should have seen the taping job on that guy - nothing fancy, just extensive. Benzoate + 4 looong strips of tape + 4 short pieces of tape helping to hold the 4 main ones in place. It may have had something to do with the fact that the CRNA had just resumed working (that day) after a few years absence, but the anesthesiologist was very supportive of all the tape use. In fact, he specified that we needed to use 1 mole of tape, which he defined as the amount of tape required to raise the share price of 3M by $0.01.
 
MedicinePowder said:
thanx for all the input; however, as a fourth year medical student i've already seen three IVs pulled out as they repositioned just prior surgery. each time the patient was intubated and though rare, i would want to secure the ETT tube as secure as possible in the one in ten thousand chance it may accidently get a 'good' tug.
Click to expand...

Yeah, sh it happens. It just happens alot less when you get to the point where you can do it in your sleep.

One of my lower moments at work this past year was...while hurrying to put a bring-back CABG on the OR table who had a systolic pressure of 70, HR of 110-120, I "helped" everyone who was positioning the patient...problem was, when we got to the table, the IJ AND the A-line were...uh...not where they were B4 the move. 😱

Teddy the heart surgeon, one of the 4 existing nice/cool heart surgeons on the planet, said "Dude, that was brilliant." :laugh:

Oh well, everyone has bad days. I just put them back in, did my gig, and brought the patient back to the ICU hemodynamically stable.

Even rock stars miss a note every once in a while.
 
What's the big deal? Was the tube so hard to put in anyway? If it comes out, put it back in. No matter how well you tape the sonofabitch, it can be pulled out. Bottom line, if it was hard to put in you tape it like its your lifeline, if it was easy then what are you worried about?
 
Noyac said:
What's the big deal? Was the tube so hard to put in anyway? If it comes out, put it back in. No matter how well you tape the sonofabitch, it can be pulled out. Bottom line, if it was hard to put in you tape it like its your lifeline, if it was easy then what are you worried about?
Click to expand...

Well said.

Hell, for the one in a million chance of coming out you could super glue it. But really, some people go way overboard (benzoin and tegaderm??). Remember, you have to take the damn thing out at the end of the case.

And for 90% of your cases, where do you think the tube is going anyway? If you're using a tube tree or other support and there's no tension on the circuit, it ain't goin' anywhere. 🙂
 
Noyac said:
What's the big deal? Was the tube so hard to put in anyway? If it comes out, put it back in. No matter how well you tape the sonofabitch, it can be pulled out. Bottom line, if it was hard to put in you tape it like its your lifeline, if it was easy then what are you worried about?
Click to expand...


Considering the cuff is inflated its conceivable that there can be harm done to the anatomy within the area. maybe some edema that will cause the second intubation to be troublesome and an OR room full of witnessess.

in otherwords to answer your question, i would be worried about a lawsuit considering this litiginous society of ours.

i'll do some journal searchs. there has to be a study deomonstarting the superiority of a particular taping style. but yes, i get you guys point. i'm just curious
 
MedicinePowder said:
i'll do some journal searchs. there has to be a study deomonstarting the superiority of a particular taping style. but yes, i get you guys point. i'm just curious
Click to expand...

I'll bet no such study exists. One, what are you gonna do? Pull on a tube with an inflated cuff and potentially damage the cords on someone just to figure out who tapes it better? And two, I can tell you who does the best taping job - I do. If you ask jpp, he'll tell you he does. Noyac? I'm sure his is best.

We all have our little quirks, and for all the other big complex crap we do in anesthesia, a little thing like the best way to tape a tube is a biggie, right up there with Mac or Miller blade (why Mac of course!!!). As long as the tube stays in (and I haven't lost one since grad school when an ENT resident pulled one trying to put in a mouth gag for a T&A) who cares? If it's that big an issue, then my guess is someone needs to be much more careful when moving the patient (turning lateral or prone, etc.). Supine and lithotomy? Again, the tube ain't going anywhere.
 
MedicinePowder said:
thanx for all the input; however, as a fourth year medical student i've already seen three IVs pulled out as they repositioned just prior surgery. each time the patient was intubated and though rare, i would want to secure the ETT tube as secure as possible in the one in ten thousand chance it may accidently get a 'good' tug.
Click to expand...

1. another consideration to ponder, before you're actually faced with it: how will you secure the ETT in a pt with full beard/moustache? and if going prone with this pt? I'm talking Kentucky hillbilly beard here.

2. regarding IVs: unless you personally inserted and taped the IV, give a quick look to any IV you inherit, whether a brand new one courtesy of the RN in ambulatory surgery unit, or one from the floor. I've seen some older IVs from the ward with barely intact taping. And the RNs from ambulatory surgery don't realize the stresses put on IVs with pt repositioning, especially when going prone. Also, make sure the IV isn't partially kinked where it's looped at the hand prior to taping - a very common reason for reduced flow rate.

3. I love it 😡 when I take a still-intubated pt to the ICU, who has had the ETT hidden under the CABG drapes for hours and hours (managing quite well with my single pass of pink tape securing it), and the first thing the respiratory tech does is totally remove the skin-friendly pink tape, and replace it with shoelaces or some other contraption - in a patient who will be extubated in only a few more hours.
 
Noyac said:
What's the big deal? Was the tube so hard to put in anyway? If it comes out, put it back in. No matter how well you tape the sonofabitch, it can be pulled out. Bottom line, if it was hard to put in you tape it like its your lifeline, if it was easy then what are you worried about?
Click to expand...

haha. you haven't done many prone cases, have you? i want to see you be so cavalier when you're going to flip a neuro case that's also going to be a 180 turn. i don't care if it's a mallampati 0 that you slam dunked a 9.0 ETT from across the room on, you'll make damn sure that tube is taped securely before you say "okay, cut." in fact, make sure you secure even a straight case (head next to you) because i don't know about you but i don't like to work under drapes, bair huggers, etc, etc.
 
VolatileAgent said:
haha. you haven't done many prone cases, have you? i want to see you be so cavalier when you're going to flip a neuro case that's also going to be a 180 turn. i don't care if it's a mallampati 0 that you slam dunked a 9.0 ETT from across the room on, you'll make damn sure that tube is taped securely before you say "okay, cut." in fact, make sure you secure even a straight case (head next to you) because i don't know about you but i don't like to work under drapes, bair huggers, etc, etc.
Click to expand...

I'm sure Noyac wasnt referring to prone cases, Volatile. Sorry, I don't agree with your assessment.
Arre you gonna make sure the tube is taped on a crash C-section before you tell them to cut?
 
jwk said:
Well said.

Remember, you have to take the damn thing out at the end of the case.

And for 90% of your cases, where do you think the tube is going anyway? If you're using a tube tree or other support and there's no tension on the circuit, it ain't goin' anywhere. 🙂
Click to expand...

Amen.
 
BOTTOM LINE
ENT residents have no damn regard for your ett as well as respective taping-watch your airway closely-these yahoos think a grade I laryngoscopic view will still be a grade I view after 8 hours of CO2 laser and excision in the oropharynx-had an accidental extubation by ent resident my first day on this rotation which he described as a "small leak...i think the cuff to the tube needs some air"-i go to the head and see my ett at the 9 cm marking and my cuff at the base of the tongue (ie slightly more than a small leak) 😱
 
New2Midwest said:
BOTTOM LINE
ENT residents have no damn regard for your ett as well as respective taping-watch your airway closely-these yahoos think a grade I laryngoscopic view will still be a grade I view after 8 hours of CO2 laser and excision in the oropharynx-had an accidental extubation by ent resident my first day on this rotation which he described as a "small leak...i think the cuff to the tube needs some air"-i go to the head and see my ett at the 9 cm marking and my cuff at the base of the tongue (ie slightly more than a small leak) 😱
Click to expand...

Its been made pretty clear in the above posts that cases involving the head and neck, prone cases, and difficult intubations warrant special attention to taping the ETT.
Other than that, you're making something out of nothing. Really. Tape it any way you want. Use Scotch tape. Tape it with one eye closed. Tape it with pink tape, white tape, medical tape, masking tape, Shrimp Cocktail, Shrimp Po-Boy, Boiled Shrimp, Fried Shrimp, Shrimp Fetuccini, Grilled Shrimp, Shrimp Omelette, Jumbo Shrimp, Cocktail Shrimp, Hot Shrimp, Cold Shrimp,.....

Bubba still scrubbing the floor with Forrest, using toothbrushes: "I think thats about it."
 
VolatileAgent said:
haha. you haven't done many prone cases, have you? i want to see you be so cavalier when you're going to flip a neuro case that's also going to be a 180 turn. i don't care if it's a mallampati 0 that you slam dunked a 9.0 ETT from across the room on, you'll make damn sure that tube is taped securely before you say "okay, cut." in fact, make sure you secure even a straight case (head next to you) because i don't know about you but i don't like to work under drapes, bair huggers, etc, etc.
Click to expand...


Your Right Volatile, I have never done a prone case. And I would treat it differently if had ever done one. I would make sure that the tube was secure for sure. :meanie:

Oh wait, I think spine day at my hosp. is mondays and tuesdays. And since I am neighbors with one spine surgeon and friends with the other one I get the majority of the requests (its definitely not my skills in the OR that gets me the requests). Therefore, I am doing about 6-8 prone cases a week and never have I had a tube pulled out on accident. Maybe I haven't done enough but the system seems to work well so far. Yes I tape it well when its going to be hard to get at if pulled but more importantly I make sure its not pulled and that nobody is in a position to pull it without me being prepared to remedy it. More important than the tape job, which as I said can always be sabotaged, is the constant awareness of the environment. YOu lose site of this and anything can happen. 😍
 
i just finished an facial bone reconstruction with a 6.5 oral rae that was taped to the mandible and the patient 180 from the workstation. all was well, my tape stayed in place, but i heard that dreaded 'boop-boop-buh-boop' coming from the drager only to look up and see no tracing on the display. my straight connector (that he had messed with prior to draping) had come unplugged. so i sez, 'hey doc i think you d/c'd my tube' to which he said, 'you need to get your @ss up here then and plug it back in.'

sometimes you just can't win. :laugh:
 
VolatileAgent said:
i just finished an facial bone reconstruction with a 6.5 oral rae that was taped to the mandible and the patient 180 from the workstation. all was well, my tape stayed in place, but i heard that dreaded 'boop-boop-buh-boop' coming from the drager only to look up and see no tracing on the display. my straight connector (that he had messed with prior to draping) had come unplugged. so i sez, 'hey doc i think you d/c'd my tube' to which he said, 'you need to get your @ss up here then and plug it back in.'

sometimes you just can't win. :laugh:
Click to expand...

Thats when I say you D/C'd it, You put it back together. I'm on the phone right now. With my broker no less. :laugh:











Just Jokin of course
 
Its been a while since this thread was viewed but the topic came up today in the OR. One of our spine pts that was done last week by a colleague of mine complained about his face being marked by the tape used to keep the tube in after being prone for 4-5 hrs. So we polled each other and we all tape the same way (silk tape). We don't currently have the pink stuff. What are you guys using for long prone cases especially in the elderly with poor skin turgor. We talked about using the straps like respiratory.
 
Noyac said:
Its been a while since this thread was viewed but the topic came up today in the OR. One of our spine pts that was done last week by a colleague of mine complained about his face being marked by the tape used to keep the tube in after being prone for 4-5 hrs. So we polled each other and we all tape the same way (silk tape). We don't currently have the pink stuff. What are you guys using for long prone cases especially in the elderly with poor skin turgor. We talked about using the straps like respiratory.
Click to expand...

I'm not a fan of modifying one's practice for what sounds like a rare complaint, a minor complaint at that.
 
jetproppilot said:
I'm not a fan of modifying one's practice for what sounds like a rare complaint, a minor complaint at that.
Click to expand...

Yeah its minor just like we told the surgeon who had to find something to complain about. So we said we would check into it. Now I've checked into it and can go on with my day.
 
jetproppilot said:
Yeah, sh it happens. It just happens alot less when you get to the point where you can do it in your sleep.

One of my lower moments at work this past year was...while hurrying to put a bring-back CABG on the OR table who had a systolic pressure of 70, HR of 110-120, I "helped" everyone who was positioning the patient...problem was, when we got to the table, the IJ AND the A-line were...uh...not where they were B4 the move. 😱

Teddy the heart surgeon, one of the 4 existing nice/cool heart surgeons on the planet, said "Dude, that was brilliant." :laugh:

Oh well, everyone has bad days. I just put them back in, did my gig, and brought the patient back to the ICU hemodynamically stable.

Even rock stars miss a note every once in a while.
Click to expand...

This maneuver is called a "full Wagner" at my institution after a resident with that name did the same (plus PA catheter). 🙂
 
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