Facial Hair and Securing the Endotracheal Tube

Abstract

To the Editor: Unintentional or accidental extubation is an undesirable complication in mechanically ventilated patients. In the operative setting, adhesive tape is used to secure the endotracheal tube (ETT) to the maxilla and/or mandible. However, this technique may not adequately secure the ETT in patients with facial hair. Taping around the neck can cause obstruction of venous return and raised intracranial pressure in susceptible patients, spinal cord injury in patients with unstable neck vertebrae, and compromised access to the internal or external jugular veins. A technique we find helpful in securing the ETT in patients with facial hair has not been described previously in the literature. In patients with sufficiently long (>1.0 cm) mustache hair, we tightly tape the mustache hair around the ETT Figure 1. This way, the possible complications associated with taping around the neck are avoided and no tape is actually placed on the patient's face. Additionally, this technique provides an advantage in securing the ETT in edentulous patients who lack sufficient maxillary and dental support beneath the lips, and it also may be used in patients who have an allergic reaction to adhesive tapes. A tube taped in this manner is secure; however, since it is possible to withdraw the ETT 1-2 cm, the cuff must be placed 3-4 cm distal to the vocal cords. We do not recommend this technique for surgery near the airway, in a position other than supine, or in long-term ventilatory management. We favor this technique because it avoids the problems of taping around the neck and is more secure than taping to the face in patients with facial hair.Figure 1: An endotracheal tube taped securely to the patient's mustache hair.Arjang Khorasani, MD David J. Bird, DO Department of Anesthesiology, University of Illinois College of Medicine at Chicago Chicago, IL 60612 and Department of Anesthesiology and Pain Management Cook County Hospital Chicago, IL 60612