Nasal tracheal tube taping - PICU SOP

Warning

Objectives

The objective of this SOP is standardise and remove variation in the taping of tracheal tubes in critically unwell children.

Scope

Neonates, infants and children who are ventilated on the paediatric critical care unit or who are anticipated to be admitted there for ventilation via a tracheal tube. 

Audience

This guidance is important for healthcare professionals involved in the taping of tracheal tubes within Paediatric Critical Care Unit.

It is also important for members of multidisciplinary teams caring for children who will ultimately be admitted for ventilatory support to Paediatric Critical Care.

Prepare

Equipment laid out
  • Check position of ETT on recent CXR
  • Consider any drug requirements 
    • Analgesia
    • Sedation
    • Paralysis
  • Discuss plan with clinical team
  • Airway equipment as intubation setup
  • Cut trouser legs (tragus to tragus length)

Checklist

Documentation image
  • Team brief & allocate roles
  • Confirm drug(s) and doses to be used
  • Clinical team and Nurse in Charge aware
  • Previous grade of intubation (WAIT chart)
  • Check ETT length at mouth
  • QRS tone on
  • Face mask & Yankeur suction at head of bed
  • BP attached (1 min cycle) on different limb to SpO2 and IV access
  • Pre-oxygenate (unless balanced circulation) & optimise ventilator settings
  • Consider suctioning ETT prior to re-taping
  • Aspirate NGT and reposition NGT tape
  • Administer drug(s) as above

Perform

Correct taping example
  • If replacing old tapes, consider loosening with AppeelTM, avoiding the eyes
  • Remove old tapes with assistant holding ETT
  • Check skin for any pressure damage
  • Ensure ETT position correct and note length
  • Deflate cuff only if repositioning ETT
Correct taping example
  • 1st tape starts OPPOSITE side to tube
  • Lower trouser leg across upper lip
  • Follow facial contours closely
Correct taping example
  • Wrap upper trouser leg over nose and then under tube
  • Angle away from nares to avoid pressure damage
  • Wrap neatly and avoid crumpling
Correct taping example
  •  Wrap around tube twice (Include cuff tubing)
  • 50% overlap each turn
  • Fold edge over end of trouser leg so it’s easy to remove
Correct taping example
  • 2nd tape starts SAME side to tube
  • Upper trouser leg over bridge of nose
  • Lower tape wraps under tube
  • Wrap twice, 50% overlap, fold edge
  • (Confirm tube cuff pressure)
Correct taping example

DOCUMENT

  • CiS event
  • Cuff pressure on CiS
  • Any pressure areas?
  • Update WAIT chart
  • PACS ‘sticky note’ (if tube repositioned)

DEBRIEF

  • Team debrief
  • Tissue viability referral?
  • Ventilator settings plan

Document & Debrief

Correct taping example

DOCUMENT

  • CiS event
  • Cuff pressure on CiS
  • Any pressure areas?
  • Update WAIT chart
  • PACS ‘sticky note’ (if tube repositioned)

DEBRIEF

  • Team debrief
  • Tissue viability referral?
  • Ventilator settings plan

Editorial Information

Last reviewed: 24/11/2020

Next review date: 24/11/2023

Author(s): Mark Davidson.

Version: 3.02

Approved By: PICU Guidelines Group