Endotracheal tube securements: Effectiveness of three techniques among orally intubated patients

Abstract

BackgroundInvasive ventilation is a common practice in intensive care units (ICUs). Once a patient is intubated, maintenance of the endotracheal tube placement is essential. When the ETT is not secured effectively, even basic nursing management can cause tube slippage which is a major factor in causing airway trauma. Aim of the studyThis study was aimed at comparing the effectiveness of three endotracheal tube securement techniques (Twill, Adhesive and Simple bow) on endotracheal tube slippage, external jugular venous pressure measurement, oral mucosa and facial skin integrity, pain intensity and on patient satisfaction after the fixation method. Subjects and methodsA randomized clinical trial was conducted at the intensive care units in Ain Shams University Specialized Hospital. It included a sample of 90 patients, randomly allocated to the three equal groups: Twill, Adhesive and Simple bow groups, 30 subjects for each. The tools used for data collection included demographic and clinical data sheet, the time profile of ETT fixation method sheet and scales for endotracheal tube (ETT) slippage, external jugular venous pressure (EJVP) measurement, oral assessment guide (OAG) for oral mucosa, Facial Skin Integrity, pain intensity and patient satisfaction procedure scale. The study maneuvers were applied according to the group. ResultsBoth ETT slippage and EJVP were measured at 15, 30, 60 and 120min post fixation method. At 120min, 73% of patients in the Twill group had no slippage compared to Simple bow (50%) and (36%) in Adhesive groups. However, at 30min post fixation method 90% of patients in the Twill group had normal EJVP measurement compared to Simple bow and Adhesive groups (70% and 57%, respectively), with a statistically significant difference between the three groups. At 60min, only 10% of patients in the Twill group had high EJVP compared to Simple bow (37%) and Adhesive groups (47%) with a statistically significant difference among them. As well, at 120min post fixation method, most patients in the Twill group (97%) had normal EJVP measurement, compared to the Adhesive (60%) and Simple bow (57%) groups. Oral mucosa and facial skin integrity assessment was done for all patients in the three study groups at 2, 6, 12, and at 24h post fixation method. For oral mucosa at 24h post fixation method, 80% of patients in the Twill group had healthy oral mucosa compared to Simple bow and Adhesive groups (47% and 37%, respectively), with a statistically significant difference between the three groups (P=0.07). For facial skin integrity, at 6h, no one of patients in the Twill and Simple bow groups had severe facial skin reaction compared to patients in the Adhesive group (7%) and the difference was statistically significant, (P=0.01). As well, a statistically significant difference was revealed among the three groups, at 12 and 24h post fixation method, (P=0.04 and 0.02, respectively). The Twill technique had the shortest time taken for application and removal of securement method than other groups. Additionally, the Twill group had the lowest scores of pain at all three assessment times (5, 10 and 20min), whereas those in the Adhesive group had the highest scores. All these differences were statistically significant, (P<0.001). Overall, 80% of patients in the Twill group were satisfied, compared to 57% in the Simple bow group, and 37% only in the Adhesive group. ConclusionIt is concluded that Twill technique is an ETT securement technique in ICUs for orally intubated patients. RecommendationsIt is recommended to use this method, with development of strategies to prevent slippage aiming at increasing patient safety after securement technique intervention.