Oral 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.
Preparation
  • 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, every 1 minute, not on limb with SpO2 or 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, loosen 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 SAME side to tube
  • Lower trouser leg under lower lip
  • Follow facial contours closely

  • Wrap upper trouser leg over the top of the tube
  • 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 across upper lip
  • Lower tape wraps under tube
  • Wrap twice, 50% overlap, fold edge
  • (Confirm tube cuff pressure)
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): Dr Mark Worrall

Version: 3.02

Co-Author(s): PICU unplanned extubation working group

Approved By: PICU Guidelines Group