Factors affecting fixation of endotracheal tube among children in intensive care units

Abstract

Background Correct positioning and proper fixation of the endotracheal tube (ETT) among children can be challenging in pediatric intensive care units (PICUs), and improper fixation may be associated with higher rates of complications. Aim The study aimed to explore factors affecting fixation of ETT among children in ICU. Patients and methods A descriptive exploratory design was utilized. Setting: the study was conducted at PICUs in two Pediatric University Hospitals affiliated to Cairo University hospitals. Sample: a convenient sample of 101 intubated children in ICUs was enrolled in the study. Tools: the required data were collected by using personal data questionnaire for child, assessment sheet of factors affecting ETT fixation in PICU, and observational checklist of securing an ETT. Results The current study results revealed that more than half of the children had improperly fixed ETT, and more than two-thirds of them were less than 1 year old and two-thirds of them were males. Years of experience of the assigned nurse in PICU less than 2 years, inappropriate child position in bed, ETT fixation with adhesive tape without tube holder, traction of ETT, inappropriate mechanical ventilator (MV) circuit position, inappropriate handling of child during performance of procedures and care, nurse shift (morning shift), incorrect ETT retaping by the assigned nurse, absence of documentation of ETT card, and increase length of stay on MV and in PICU were statistically significant factors associated with improper ETT fixation. Conclusion Absence of salivary secretions in child mouth was the most frequent finding in children with properly fixed ETT, followed by appropriate MV circuit position, appropriate child position in bed, experience of the assigned nurse of more than 2 years in PICU, passive movement of child, no traction of ETT, and appropriate handling of child. On the contrary, ETT fixation with adhesive tape without tube holder was the most frequent finding in children with improperly fixed ETT followed by no documentation of ETT card, uncuffed ETT, morning shift, stay in PICU more than 2 weeks, MV days more than 1 week, and nurse’s experience in PICU of less than 2 years. Recommendations Standard method of fixation of ETT should be used in all children by adhesive tape with tube holder, and also ETT position should be checked and documented with every nursing shift.