Securing an Endotracheal Tube

Goal: The tube remains in place, and the patient maintains bilaterally equal and clear lung sounds.

1. Bring necessary equipment to the bedside stand or overbed table.

2. Perform hand hygiene and put on PPE, if indicated.

3. Identify the patient.

4. Close curtains around bed and close the door to the room, if possible.

5. Assess the need for endotracheal tube retaping. Administer pain medication or sedation, as prescribed, before attempting to retape endotracheal tube. Explain the procedure to the patient.

6. Obtain the assistance of a second individual to hold the endotracheal tube in place while the old tape is removed and the new tape is placed.

7. Adjust the bed to a comfortable working position, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Lower side rail closest to you. If the patient is conscious, place him or her in a semi-Fowler’s position. If the patient is unconscious, place him or her in the lateral position, facing you. Move the overbed table close to your work area and raise to waist height. Place a trash receptacle within easy reach of work area.

8. Put on face shield or goggles and mask. Suction patient as described in Skill 14-8 or 14-9.

9. Measure a piece of tape for the length needed to reach around the patient’s neck to the mouth plus 8 inches. Cut tape. Lay it adhesive-side up on the table.

10. Cut another piece of tape long enough to reach from one jaw around the back of the neck to the other jaw. Lay this piece on the center of the longer piece on the table, matching the tapes’ adhesive sides together.

11. Take one 3-mL syringe or tongue blade and wrap the sticky tape around the syringe until the nonsticky area is reached. Do this for the other side as well.

12. Take one of the 3-mL syringes or tongue blades and pass it under the patient’s neck so that there is a 3-mL syringe on either side of the patient’s head.

13. Put on disposable gloves. Have the assistant put on gloves as well.

14. Provide oral care, including suctioning the oral cavity.

15. Take note of the ‘cm’ position markings on the tube. Begin to unwrap old tape from around the endotracheal tube. After one side is unwrapped, have assistant hold the endotracheal tube as close to the lips or nares as possible to offer stabilization.

16. Carefully remove the remaining tape from the endotracheal tube. After tape is removed, have assistant gently and slowly move endotracheal tube (if orally intubated) to the other side of the mouth. Assess mouth for any skin breakdown. Before applying new tape, make sure that markings on endotracheal tube are at same spot as when retaping began.

17. Remove old tape from cheeks and side of face. Use adhesive remover to remove excess adhesive from tape. Clean the face and neck with washcloth and cleanser. If patient has facial hair, consider shaving cheeks. Pat cheeks dry with the towel.

18. Apply the skin barrier to the patient’s face (under nose, cheeks, and lower lip) where the tape will sit. Unroll one side of the tape. Ensure that nonstick part of tape remains behind patient’s neck while pulling firmly on the tape. Place adhesive portion of tape snugly against patient’s cheek. Split the tape in half from the end to the corner of the mouth.

19. Place the top-half piece of tape under the patient’s nose. Wrap the lower half around the tube in one direction, such as over and around the tube. Fold over tab on end of tape.

20. Unwrap second side of tape. Split to corner of the mouth. Place the bottom-half piece of tape along the patient’s lower lip. Wrap the top half around the tube in the opposite direction, such as below and around the tube. Fold over tab on end of tape. Ensure tape is secure.

21. Auscultate lung sounds. Assess for cyanosis, oxygen saturation, chest symmetry, and stability of endotracheal tube. Again check to ensure that the tube is at the correct depth.

22. If the endotracheal tube is cuffed, check pressure of the balloon by attaching a handheld pressure gauge to the pilot balloon of the endotracheal tube.

23. Assist patient to a comfortable position. Raise the bed rail and place the bed in the lowest position.

24. Remove face shield or goggles and mask. Remove additional PPE, if used. Perform hand hygiene.