The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

Effects of Airway Stabilization Methods on Incidence of Accidental Extubations in the NICU

Kathleen Deakins RRT-NPS, Beverly Capper-Michel RN, Michelle Walsh MD, Anita Shah MD Timothy Myers RRT-NPS. Rainbow Babies & Children's Hospital. Cleveland, Ohio.

Introduction: Infants require intubation and mechanical ventilation for conditions that result in atelectasis, decreased lung compliance, and reduced alveolar ventilation. Stabilization and maintenance of artificial airways is essential to prevent accidental extubations (AE) and prevent airway damage. In 2001, 53% of infants under 1500g required re-intubation following AE in our institution. A Performance Improvement project was initiated to evaluate different methods of airway stabilization and reassess the incidence of AE.

Methods:
 Endotracheal tubes (ETT) of 194 intubated infants in the NICU were secured by one of four

Methods: Type I: a 3-inch piece of 1/2-inch elastoplast was applied above the upper lip following application of tincture of benzoin. One 6-inch piece of pressure-sensitive 1/2-inch 3M cloth adhesive tape was applied over the elastoplast above the upper lip, wrapped around the ETT twice, and secured to the opposite side of the face. The procedure was repeated from the upper lip on the opposite side of the face. A cover piece was applied. Type II: an elastoplast base piece was applied over tincture of benzoin followed by a 6-inch piece of pressure -sensitive ΒΌ-inch 3M cloth adhesive tape applied to one side of the face and wrapped up the ETT in a spiral fashion and tabbed at the top. Procedure was repeated from the opposite side of the face followed by a third, cover piece. Type III: a NEO-fit ETT securing device was utilized with 1-inch Duoderm circles applied over the tyvek tabs on both cheeks, Type IV: New and improved 3M cloth adhesive tape was applied over tincture of benzoin using Type I procedure without elastoplast base. Data collected included weight, date of intubation, type of tape/method, number of readjustments, amount of time required to readjust ett, and type of extubation: planned or accidental.

Results
: Data analysis included the number accidental extubations, adjustments and cost per 100 ventilator days, time (minutes) required for adjustments and cost analysis of all methods. Results are shown in the table below catgeorized by weight as > or < 1500 grams:

Method and Type of Stabilization AE per 100 ventilator days Adjustments  per 100 ventilator days Total cost per Adjustment RRT/RN Total Cost per Adjustment RRT/RRT Total Cost per 100 ventilator days
TypeI <1500g 8.12 15.23 4.67 4.40 $73.37
Type I >1500g 7.27 21.82 4.67 4.40 $103.95
Type II <1500g 21.43 60.71 4.67 4.40 $289.58
Type II > 1500g 4.55 18.18 4.67 4.40 $86.22
Type III <1500g 2.20 4.4 .31 .31 $25.21
Type III >1500g 7.34 13.76 .31 .31 $83.92
Type IV <1500g 3.50 11.89 4.67 4.40 $56.51
Type IV >1500g 2.65 14.29 4.67 4.40 $67.49



CONCLUSION:
In infants < 1500 grams, the quality of airway stabilization was improved when using the NEO-fit endotracheal tube holder as the number of accidental extubations, time required for adjustment, and total patient cost was decreased. Despite aslightly increased time for ett adjustment, New and Improved 3M Cloth Adhesive Tape reduced the number of accidental extubations and total patient cost in infants > 1500g.

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