Positive Outcomes for Pressure ulcer Prevention involving Endotracheal Tube Fixation

Background:

Critical Care   patients are identified high risk as Braden Scores are lower, multiple co-morbidities and the presences of numerous tubes and devices at risk of creating pressure ulcers.  It was noted a number of the pressure ulcers developed from fixation of Endotracheal tubes.   Carondelet St. Mary’s Hospital, 40 bed intensive care unit.

Tape had been used to secure the endotracheal tubes for several years following   complication with a product which had been previously on the market.    Prevention included assessment by RN every shift and by RT during rounding.   Taping   would be replaced a minimum of every 48 hours and position of the tubing changed, skin and mucosal membrane assessment and documentation of findings.

Taping limitations were identified as : pressure ulcers continued to develop with close monitoring,  interfering with oral care, involved two team members : 2 RN’s , 2 RT or a combination of 1 RN and 1 RT it was not cost effective for frequent changes.

A product trial of three products * was conducted and one product * selected based on   feedback from Critical Care Nurses   and Respiratory Therapist. 

Outcome:

Following product evaluation of three devices one device was selected and implemented into the prevention protocol.  Since implementation December 2009 there have been no breakdowns noted on the mucosal membranes and  the lips.