The Science Journal of the American Association for Respiratory Care

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.

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