Nasal tracheal tube taping - PICU SOP

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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 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
  • 1st 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
 
  • 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)
 

 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

 

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 November 2020

Next review: 24 November 2023

Author(s): Mark Davidson

Version: 3.02

Co-Author(s): Unplanned Extubation Quality Improvement Working Group, Paediatric Critical Care

Approved By: PICU Guidelines Group