Reducing Pressure Ulcers and Skin Issues to the Face and Lips Related to Endotracheal Tube Securement

The purpose of this quality initiative was to decrease the rate of facility acquired pressure ulcers and skin issues to the face and lips related to securement of endotracheal tubes (ET).  After a trend was identified by the critical care CNS, WOC nurses, ICU staff, and respiratory therapy staff, a meeting was held with the Chief Medical Critical Care Physician to discuss alternative devices to secure ET tubes.  The trial was completed in one of two critical care units . The patients with an even medical record number received an ET tube fastener.  The tube was rotated to the opposite side of the mouth every two hours. The second group of patients with an odd medical record number had their ET tube secured using the current practice of skin prep to the face and the tube was secured with silk tape. With this method the lips were assessed at least each shift and the tube was moved and retaped as needed. 50 patients were included in each group. Of the 50 patients using the tube fastener, 3 patients developed issues to the lips. These issues were seen on day 1, 5 and 7. Of the 50 patients that received the silk tape securement, 8 patients developed skin issues ranging from one sore under nose, one sore to cheek, and issues to the lips. These issues were seen on day 2, for 2 patients and day 3, 4, 5, 6, 8 and 15. After discussing the findings with the Medical Critical Care Physician, this information was communicated to the product selection committee and a decision was made to change to the ET tube fastener.  In conclusion positive results were seen with a reduction in pressure ulcers and skin issues achieved with a change in practice through a collaborative approach.