Nasal tracheal tube taping - PICU SOP

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

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

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

	If replacing old tapes, consider loosening with Appeel^TM, 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
	1^st tape starts OPPOSITE side to tube Lower trouser leg across upper lip Follow facial contours closely
	Wrap upper trouser leg over nose and then under tube Angle away from nares to avoid pressure damage Wrap neatly and avoid crumpling
	Wrap around tube twice (Include cuff tubing) 50% overlap each turn Fold edge over end of trouser leg so it’s easy to remove
	2^nd 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)
	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