Securing an En Do Tracheal Tube

8/3/2019 Securing an En Do Tracheal Tube

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Polyvinylchloride airway that is insertedthrough the nose or mouth into the tracheausing laryngoscope.

Provide an airway for patients who cannotmaintain a sufficient airway on their own.

Patients who have endotracheal tube have ahigh risk for skin breakdown.


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Assisstant 1 tape

Disposable gloves

Scissors Washcloth and cleaning agent

Skin barrier

Adhesive remover swab

Towel

Sterile saline or water


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Poratble/wall suction unit with tubing Sterile suctioning kit

Razor

Shaving cream Hand held pressure gauge


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Assess for the need for retaping Assess lung sounds to obtain baseline

Assess oxygen saturation level

Assess the chest for chest symmetric riseand fall during respiration

Assess patients need for pain medication andsedation.


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Risk for impaired skin integrity Impaired oral mucous membrane

Risk for infection

Risk for injury


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The tube remains in place and the patientmaintains bilaterally equal and clear lungsounds.


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1. Identify the patient. 2. Assess the need for endotracheal tube

retaping. Administer pain medication orsedation as prescribed before attempting toretape endotracheal tube. Explain theprocedure to the patient.

3. Obtain the assistance of a second

individual to hold the endotracheal tube inplace while the old tape is removed and thenew tape is placed.


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4. Perform hand hygiene. 5. Adjust bed to comfortable working

position. Lower side rail closer to you. Ifpatient is conscious, place him or her in asemi-Fowlers position. If patient isunconscious, place him or her in the lateralposition, facing you. Move the overbed tableclose to your work area. Place a trashreceptacle within easy reach of work area.


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6. Put on face shield or goggles and mask.Suction patient as described in Skill 14-10 or 14-11. Remove face shield or goggles and maskafter suctioning.

7. Measure a piece of tape for the length needed

to reach around the patients neck to the mouthplus 8. Cut tape. Lay it adhesive side up on thetable.

8. Cut another piece of tape long enough toreach from one jaw around the back of the neck

to the other jaw. Lay this piece on the center ofthe longer piece on the table, matching thetapes adhesive sides together.


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9.Take one 3-mL syringe or tongue blade andwrap the sticky tape around the syringe untilthe nonsticky area is reached. Do this for theother side as well.

10. Take one of the 3-mL syringes or tongueblades and pass it under the patients neck sothat there is a 3-mL syringe on either side ofthe patients head.


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14. Carefully remove the remaining tape fromthe endotracheal tube. After tape is removed,have assistant gently and slowly moveendotracheal tube (if orally intubated) to theother side of the mouth. Assess mouth forany skin breakdown. Before applying newtape, make sure that markings onendotracheal tube are at same spot as whenre-taping began.


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15. Remove old tape from cheeks and side offace. Use adhesive remover to remove excessadhesive from tape. Clean the face and neckwith washcloth and cleanser. If patient has

facial hair, consider shaving cheeks. Patcheeks dry with the towel.


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16. Apply the skin barrier to the patients face(under his nose, cheeks, under lower lip)where the tape will sit. Unroll one side of thetape. Ensure that nonsticky part of tape

remains behind patients neck while pullingfirmly on the tape. Place adhesive portion oftape snugly against patients cheek. Split thetape in half from the end to the corner of themouth.


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17. Place the top-half piece of tape under thepatients nose. Wrap the lower half aroundthe tube in one direction, such as over andaround the tube. Fold over tab on end of

tape.


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18. Unwrap second side of tape. Split to cornerof the mouth. Place the bottom-half piece oftape along the patients lower lip. Wrap thetop half around the tube in the opposite

direction, such as below and around the tube.Fold over tab on end of tape.


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19. Auscultate lung sounds. Assess forcyanosis, oxygen saturation, chest symmetry,and stability of endotracheal tube. Againcheck to ensure that the tube is at the correctdepth.

20. If endotracheal tube is cuffed, checkpressure of balloon by attaching a hand-heldpressure gauge to the pilot balloon of theendotracheal tube.


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21. Remove face shield or goggles and mask.Remove gloves and perform hand hygiene.Assist patient to a comfortable position. Raisebed rail.

Securing an En Do Tracheal Tube

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