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How to Tape an ETT That Won’t Come Out

September 4, 2020

Written by Aaron Lacy

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When comparing taping methods to secure an ETT, a generous amount of non-torn tape secured bilaterally and as laterally as possible on the face required the most force to extubate.

Why does this matter?
Inadequately secured ETTs may be a contributing factor to unplanned extubation. If there is a method of securing tubes that will lead to a decreased chance of extubation, it seems like a simple step to take.

Tales of the tape
This group of anesthesiologists evaluated the structural integrity of 5 methods of taping ETTs. After taping, they measured the force required to extubate (both gradual increases in force and sudden, quick application of force) and the “peel angle” (angle of the tape relative to the cheek as the tube is displaced).

The 5 methods of taping used were:

From cited article: A = full tape bilateral, B = torn tape unilateral, C = full tape lower, D = full tape unilateral, E = torn tape bilateral, F = well…don’t do that

Methods A (full tape bilateral) and E (torn tape bilateral) seemed to be particularly resistant to forced extubation, while type B (torn tape unilateral) was the most vulnerable. In taping methods with torn tape (B, E) the mechanism of failure seemed to be related to ripping of tape as force was applied.

So what do we take away from this? While it may seem like a trivial step, in a controlled environment how we tape an ETT showed a significant difference in the force required to extubate. In general, we should use non-ripped taped that is secured on both sides of the face, as lateral as possible. This study could also help establish a “standard” of taping that then could be more rigorously compared to commercial ETT securement devices.

Source
Characterizing the Structural Integrity of Endotracheal Tube Taping Techniques: A Simulation Study. Anesth Analg. 2020 Aug;131(2):544-554. doi: 10.1213/ANE.0000000000004206.

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