Phase III of A Multi-Phase Interdisciplinary Study Aimed at Reducing Endotracheal Tube Device-Related Hospital Acquired Pressure Ulcers in ICU and CVICU

Purpose:    1) To decrease incidence of device-related hospital-acquired pressure ulcers (HAPUs) in ICU/ CVICU by standardizing the re-taping process for endotracheal tubes (ETT),   and 2) to identify attitudes of Registered Nurses, (RN’s) and Respiratory Therapists (RT’s) regarding tape vs. a commercial ETT stabilizer.

Background:   A phase II study using a commercial adjustable ETT stabilizer improved, but did not eliminate, the incidence of facial/mucosal HAPUs from ETT.  We continued to study ETT stabilization methodology in our network hospital Level 1 Trauma ICU and CVICU.

Method:  An anonymous six question semi-structured qualitative survey using survey monkey was sent to every ICU/CVICU RN and RT prior to study intervention.  Next, education about a new standard work process for taping and/or using a commercial stabilizer for ETT was provided.  The RT educator audited the process for 4 weeks post intervention.  The same survey was distributed post intervention.

Results:   109 patients were audited over four weeks.  Tape was used on 107 patients; commercial stabilizers on 2 patients, both had beards.  11 patients, using tape, developed blanchable redness on the face.  RT’s notified RN’s of skin alterations as part of the standard work process.  There were zero HAPUs during the audit and also during the next quarterly prevalence study. 

The majority of survey respondents were nurses. (RN = 28; RT = 13.).  68% of respondents agreed tape is a causative factor in the development of facial/mucosal HAPUs, and 55% agreed commercial stabilizers facilitated easer tube repositioning and inspection than tape.  But only 39% respondents agreed a commercial ETT stabilizer is effective in prevention of HAPUs. 

Conclusion:  Tape is a causative factor in the development of facial/mucosal HAPUs but commercial ETT stabilizers are not necessarily more effective in preventing HAPUs.   A standardized re-taping process for ETT was effective in prevention of HAPUs associated with ETT stabilization.