PA PSRS Patient Saf Advis 2005 Mar;2(1):16.
Ask the Analyst: Securing Tracheal Tubes
Anesthesiology; Critical Care; Nursing; Pulmonary Medicine
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PA-PSRS recently received a report describing a male patient who self-extubated an oral endotracheal tube. The report stated that the patient did not experience respiratory distress due to the extubation. The tube was taped to the patient’s face; however, the patient had a beard, and the report suggests this may have played a role in the extubation. The patient’s beard may have inhibited the adhesive tape from strongly adhering to the face, allowing unintentional movement of the tube, which could result in self-extubation. In the report, clinical staff posed the question, “Should we consider looking at the tape we are using?”

Adhesive characteristics vary depending on the type of tape. For instance, paper tape may not have as strong adhesion properties as cloth or vinyl tapes. However, strong adhesion may cause discomfort or injury to sensitive skin when removed. Clinicians may want to consider choosing tape to secure tracheal tubes based on an assessment of each patient’s physical characteristics (e.g., frail skin, beard) to ensure that the tube is securely in place and to minimize discomfort or injury from tape removal.

Adhesive tape is not the only means of securing a tracheal tube to a patient. Disposable, single-use, restraints are available to secure an intubated tracheal tube to a patient. The restraint, attached to the tracheal tube, may be made of foam or cloth/cotton strips placed around a patient’s neck or head secured with a fastener such as Velcro®, a Velcro-like product, or tape. A restraint may provide better support than tape alone.

If you have questions regarding specific patient safety issues you would like PA-PSRS to investigate—particularly related to equipment or medications—we would like to hear from you.

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