The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

ENDOTRACHEAL TUBE HOLDER DEVICE VERSUS TAPE

Authors:  Lisa Cracchiolo, RCP, RRT, Barnes-Jewish Hospital, St. Louis, MO; Donna Prentice, APRN, BC, CCRN, Barnes-Jewish Hospital, St. Louis, MO; Nancy Lane, APRN, BC, Barnes-Jewish Hospital, St. Louis, MO; Kitty Bess, RN, Barnes-Jewish Hospital, St. Louis, MO; Donna Clayton, BS, RRT, Barnes-Jewish Hospital, St. Louis, MO; Marin Kollef, MD, Barnes-Jewish Hospital, St. Louis, MO

Objective:  Determine the safety of the Hollister E-TAD endotracheal (ET) tube holder to conventional tape.

Design: Prospective daily evaluation of the positioning of ET tubes. Inclusion criteria; all intubated patients in the medical intensive care unit (MICU) at Barnes-Jewish Hospital. Patients had ET tubes secured with either tape or the Hollister E-TAD ET tube holder. The device used was determined by the bedside clinician (RN/RT) based on personal preference. Exclusion criterion was any newly-intubated patient, until confirmation of acceptable initial tube placement. 

Method:  All intubated patients in the MICU have a daily morning chest X-ray performed to evaluate patient progress and ET tube positioning. The attending pulmonary physician or pulmonary fellow read all Chest X-rays prior to morning rounds. Physicians were blinded to the type of holding device utilized. The attending physician or pulmonary fellow was asked to assess the position of the ET tube as to whether it was too low or too high. Responses were compared with the device used to secure the ET tube. 

Results: 488 (285 tape and 203 ET tube holder) observations were completed from October, 2005 until March, 2006. Fifty-three patients (11%) required ET tube repositioning. Thirty-six patients (12.6%) required repositioning with tape and seventeen (8.4%) required repositioning with the holder (see below).

  Tube Moved Up Tube Moved Down No Change in Tube
Tape (n=285) 28 (9.8%) 8 (2.8%) 249 (87.4%)
Holder (n=203) 8 (3.9) 9 (4.4%) 186 (91.6%)

There is a 000.6 statistical difference in tubes moving up when utilizing tape compared with utilizing the Hollister E-TAD ET tube holder.

Conclusion:  ACLS guidelines state that an ET tube should be secured with a commercial holding device.  Clinicians are cautious to change from tape, related to the fear of tubes becoming dislodged.  The Hollister E-TAD ET tube holder is safe and effective, and may provide less movement of ET tubes compared with tape. 


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