Phase II of A Multi-Phase Interdisciplinary Study Aimed at Reducing Endotracheal Tube Device-Related Hospital Acquired Pressure Ulcers in CCU Patients

Purpose: 1) To decrease incidence of device-related hospital-acquired pressure ulcers (HAPU) in CCU by  using a commercial endotracheal tube (ETT) stabilizer and 2) to identify attitudes of Registered Nurses, (RN’s) and Respiratory Therapists (RT’s) regarding change from tape to commercial stabilizer.

Background: Routine skin rounds in CCU revealed increasing numbers of device-related HAPU on the head and neck.  Results of our Phase I study indicated need for interdisciplinary study between nursing and respiratory therapy for an alternative for ET tube securement.

Method: A descriptive quasi-experimental intervention study was implemented.  An anonymous three question semi-structured qualitative survey using survey monkey was sent to every CCU RN and RT for 10 days prior to study intervention.  Then for 2 months, a commercial adjustable ETT stabilizer with adjustable head strap was used on all CCU patients intubated for greater than 48 hours.  The RT educator randomly audited 3-4 patients/week for a total of 29 audits. The same survey was distributed post intervention to CCU RN’s and RT’s.

Results: One upper lip deep tissue injury was found for a statistically insignificant 3.4% incidence rate.  The RT, RT educator and Wound Care NP determined incorrect application technique was likely cause of injury.   Thirty-two RN’s/RT’s completed the post survey.  62.5% agreed/strongly agreed tape is a causative factor in facial HAPU’s; 59.4% agreed/strongly agreed a commercial ETT stabilizer facilitated tube repositioning & inspection; and 50.1 % agreed/strongly agreed the stabilizer is effective in preventing facial HAPU’s.

Conclusion:  A commercial adjustable ETT stabilizer can be effective in decreasing, but not necessarily in eliminating device-related HAPU.  While RN’s and RT’s strongly agree tape is a causative factor, only 50% agreed a commercial stabilizer is a completely effective alternative.  Education and reinforcement of correct application technique is necessary.

Next Steps:  Replication of this study in ICU/Level I Trauma unit.