2004 OPEN FORUM Abstracts
A RETROSPECTIVE STUDY OF AN ALTERNATIVE METHOD OF TUBE MEASUREMENT DURING PEDIATRIC BURN TRANSPORT
TRAVIS
COLLINS BS RRT, BRAD CARMAN RRT, THOMAS CAHILL RRT, TERESA MERK
BSN RN, RICHARD KAGAN MD, JOHN McCALL MD. Shriners Burns
Center-Cincinnati, Cincinnati, Ohio.
Background:
A secure airway is
extremely important for the pediatric burn patient. The pediatric
airway is of paramount importance during the fluid resuscitation
phase when facial and airway edema is at its peak and re-intubation
would be difficult. For this reason, it is critical for a caregiver
to track ETT placement, after confirmed placement by chest x-ray.
There are many different methods and devices on the market that are
capable of securing an ETT. Many of these devices can be cumbersome
and make it difficult to check ETT placement because the number
markings are concealed often leaving the caregiver to speculate where
the actual ETT is positioned.
Methods: This is a retrospective
study of pediatric burn patients who were intubated at a referring
facility and were transported by Shriners Hospital for Children -
Cincinnati Transport Team. The data collected included age, total
body surface area burned (TBSA%), body surface area full thickness,
ETT size, ETT location (oral/nasal), How many centimeters out the ETT
measures, ETT resecured for transport, the amount an ETT moved during
transport, accidental extubation, X-ray conformation, EtCO2
measured, and SpO2 measured. ETT placement was tracked by
the use of a tape measure to document the length of the ETT external
to the patient. Once the ETT placement is confirmed by chest x-ray, a
measure is made of the length of ET tube between the end of the tube
to the patient's teeth/gums or nasal septum. During transport this
measurement is obtained and documented with each patient movement
(bed to stretcher, in/out of ambulance or aircraft). Averages of five
measurements were obtained during each transport.
Results: All
patients (n = 79) between January 12, 2001 to August 20, 2003 were
retrospectively reviewed. Patient age ranged form 1 month to 17 years
with a mean of 5.7 years. Mean TBSA 43.6 % with a full thickness of
34.8 %. The average ETT size was 5.0 with the mean distance
measurement of 8.7 cm. Of the patients 94.9% were orally intubated
and 5.1% were nasally intubated. 87% of the patients had ETT
resecured for transport. Six patients had ETT movement during
transport that was l cm or less. There were no occurrences of tube
dislodgment during transport. All patients had X-rays reviewed for
proper ETT placement, EtCO2 measured, and SpO2
measured during all phases of transport.
Conclusion: The
use of a disposable inexpensive tape measure can provide a clinician
with a tool that aid in accurate documentation of ETT placement
during transport. This method overcomes barriers such as tape and
bite blocks that often make it difficult to see number markings on an
airway.