A prospective consideration was done to compare four different orders of securing oral endotracheal tubes: adhesive tape (A).

A prospective consideration was done to compare four different orders of securing oral endotracheal tubes: adhesive tape (A), Twin tape (T) Twin tape with FlexBlue bite mould (TFXB), and Velcro tie with FlexBlue (VFXB) used onward sequential days. Thirty-six patients were registered for 136 patient-days and 18 had unbroken 4-day cycles. The methods were evaluated twice daily by dint of nurses, respiratory therapist, and patient, forward a five-point Likert scale with regard to oral hygiene, patient comfort, pamper satisfaction, and ease of use. Tube motion relative to the incisor teeth was measured at last of shift, the use of a bite brace was noted, and near extubations were documented. Analysis of variance and Student's t example with Bonferroni correction were performed. Adhesive tape had 33 patient-days, 04[+ or -]07 cm motion 3.4[+ or -]0.9 oral hygiene, 40[+ or -]08 comfort, 42[+ or -]06 foment satisfaction, and 4.2[+ or -]07 ease of use. Twill tape had 34 patient-days, 07[+ or -]11 cm motion 3.0[+ or -]0.7 oral hygiene, 31[+ or -]09 comfort, 28[+ or -]10 nourish at the breast satisfaction, and 3.3[+ or -]11 ease of use. Twill tape with FlexBlue bite shape had 35 patient-days, 1.3[+ or -]20 cm motion 2.5[+ or -]1.2 oral hygiene, 19[+ or -]11 comfort, 1-9[+ or -]10 succor satisfaction, and 2.1[+ or -]11 ease of use. Velcro tie with FlexBlue had 34 patient-days, 08[+ or -]10 cm motion 1.9[+ or -]1.2 oral hygiene, 15[+ or -]14 comfort, 16[+ or -]10 nourish at the breast satisfaction, and 1.8[+ or -]11 ease of use. Statistical analysis showed no difference between the form into groupss for tube movement. Method A was statistically superior to VFXB and TFXB forward all other parameters, and T upon all except oral hygiene. Twill tape was superior to VFXB upon all, and TFXB on patient comfort, promote satisfaction, and ease of use. There was no significant difference between TFXB and VFXB forward any measured parameter. Adhesive tape and T required an oral airway upon only 14 days compared with 69 days of FlexBlue use. Extubation forward 2 and near extubation occurr in succession 18 occasions with FlexBlue use and no other than once with T and accounted for greatest in quantity decisions to change securing [i]modus operandi[/i] We cannot recommend the use of the FlexBlue theory for securing oral endotracheal tubes.

(Chest 1993; 104:1537-40)

A = adhesive tape; T = Twill tape; TFXB = Twill tape with FlexBlue

bite block; VFXB with FlexBlue bite bock

Endotracheal tubes are required for Positive influence mechanical ventilation and must be securely held in position to avoid accidental extubation or malposition. Commonly used way s of securing endotracheal tubes include adhesive tape (A), twill tape (T) and a wide variety of endotracheal tube holders[12] However, to our knowledge, none of these orders has been compared and evaluated with regard to which is the ideal way of securing the endotracheal tube. No best process may exist, rather a trade-off between keeping the tube in and patient comfort must be made. While there is extensive literature upon accidental extubation, the literature does not relate accidental extubation to taping processs or the presence of a bite block

This subject of attention compares four different methods of securing oral endotracheal tubes in critically ill patients requiring mechanical ventilation. These rules were evaluated for tube move skin breakdown, mouth hygiene, patient comfort, nourish satisfaction, and ease of use.

METHODS

Four orderly dispositions of securing endotracheal tubes in routine use at University Hospital, Albuquerque, were prospectively evaluated from one side of to the other a 7-month period. The following rules were used: adhesive tape (A), Twill tape (T) with FlexBlue bite stop up (TFXB), and Velcro tie with FlexBlue (VFXB) Patients were recorded in the study starting with the way designated for use that day. Each afternoon the securing device was changed to the nearest method to be evaluated, in the order as listed above.

The adhesive way uses a 1-m length of 2-cm adhesive tape. Moleskin was applied to the area of tape that protects the back of the neck as well-as; not only-but also; not only-but; not alone-but tape ends were split and individual split was wrapped around the endotracheal tube and the other secur through the whole extent of the face and the upper lip to the opposite cheek. The deed was repeated with the other expiration of the tape.

The T way was a modification of the regularity described by Dunleap.[1] A 1-m long duration of T was folded in half and nooseed around the endotracheal tube. The conclusions were brought through this loophole and then tightened by pulling the periods The one was passed around the patient's head, below the same ear, while the other fall of the curtain passed above the other ear. The sum of two units ends were tied in a bend down on the cheek. This was repeated with a inferior piece of T so that couple ties secured the endotracheal tube.

The FlexBlue bite block up has a slit in the middle section and is mold to partially wrap around the endotracheal tube (Fig 1) The FlexBlue and ties were donated by way of the manufacturer (King Systems Corporation, Noblesville, Ind). All nursing and respiratory therapy staff were instructed in the use of the FlexBlue device on a representative of the manufacturer. The TFXB and VFXB arrangements were similar except that T was used with common method and Velcro with the other. Either T or Velcro was threaded end the slit of the FlexBlue and a aperture formed. The tapered end of the FlexBlue was inserted into the center of the month through the whole extent of the tongue and between the teeth The turn was passed around the endotracheal tube and then chanceed securely around the endotracheal tube. common end was brought around the back of the head and tied (T) to the other fall of the curtain or secured using the Velcro mechanisin. The endotracheal tube was then attached to the fall of the curtain of the FlexBlue with A (Fig 2)

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