A Comparison of the Haider Tube-Guard® Endotracheal Tube Holder Versus Adhesive Tape to Determine if This Novel Device Can Reduce Endotracheal Tube Movement and Prevent Unplanned Extubation

Abstract

BACKGROUND:Endotracheal tube security is a critical safety issue. We compared the mobility of an in situ endotracheal tube secured with adhesive tape to the one secured with a new commercially available purpose-designed endotracheal tube-holder device (Haider Tube-Guard®). We also observed for the incidence of oropharyngeal or facial trauma associated with the 2 tube fixation methods.METHODS:Thirty adult patients undergoing general anesthesia with neuromuscular blockade were prospectively enrolled. Immediately after intubation, a single study author positioned the endotracheal tube tip in the distal trachea using a bronchoscope. Anesthesiologists caring for patients secured the tube in their normal fashion (always with adhesive tape). A force transducer was used to apply linear force, increasing to 15 N or until the principal investigator deemed that the force be aborted for safety reasons. The displacement of the endotracheal tube was measured with the bronchoscope. Any tape was then removed and the endotracheal tube secured with the Haider Tube-Guard device. The linear force was reapplied and the displacement of the endotracheal tube measured. The Haider Tube-Guard device was left in place for the duration of the case. The patient’s face and oropharynx were examined for any evidence of trauma during surgery and in the recovery room. On discharge from the postanesthesia care unit, the patient answered a brief survey assessing for any subjective evidence of minor facial or oropharyngeal trauma.RESULTS:Under standardized tension, the endotracheal tube withdrew a mean distance of 3.4 cm when secured with adhesive tape versus 0.3 cm when secured with the Haider Tube-Guard (P <0.001). Ninety-seven percent of patients (29/30) experienced clinically significant endotracheal tube movement (>1 cm) when adhesive tape was used to secure the tube versus 3% (1/30) when the Haider Tube-Guard was used (P <0.001). Thirty percent of patients (9/30) were potentially deemed a high extubation risk (endotracheal tube movement >4 cm) when the endotracheal tube was secured with tape versus 0% (0/30) when secured with the Haider Tube-Guard (P = 0.004). Six patients with taped endotracheal tubes required the traction to be aborted before 15 N of force was achieved to prevent potential extubation as the tape either separated from the face or stretched to allow excessive endotracheal tube movement. None of the patients appeared to sustain any injury from the Haider Tube-Guard device.CONCLUSIONS:The Haider Tube-Guard significantly reduced the mobility of the endotracheal tube when compared with adhesive tape and was well tolerated in our observations.

Effect of Accidental and Self Extubation on Mechanically Ventilated Patients’ Outcomes in Intensive Care Units

“…Buckley et al(2016) (23) supported the findings of the current study, they demonstrated how the use of Haider Tube-Guard compared to the adhesive tape and gauze role tap reduces the displacements of the endotracheal tube and decreasing the risk of UE. While the adhesive tape sticks to the surface of the patient face, the anchoragesof the tube of Haider Tube-Guard are fixed to the maxilla and jaw thus reducing the movements of the endotracheal tube.…”

Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation

“…Reintubation is associated with complications including aspiration, fatal arrhythmia, cardiac arrest, and death [5,6]. Risk factors for unplanned extubation (even in the presence of physical restraints) also include disturbance in the fixation device, pain, sedation and weaning protocols, an impaired level of consciousness upon ICU admission, and the presence of nosocomial infection [7,8]. Unplanned extubation and reintubation are associated with increases in the likelihood of ventilator-associated pneumonia (13.8%e 27.6%), length of stay in the ICU (9e22 days), length of stay in the hospital (18e34 days), and number of days on mechanical ventilation (6 days) [9].…”

Comparison of the effectiveness of endotracheal tube holder with the conventional method in a manikin model

“…Researchers and experts have noted the importance of using the safest tools to fix the ET tube. [ 7 8 9 12 13 14 15 16 ] The Thomas tube holder was superior to adhesive tape in securing the ET tube in a mannequin to log roll, chest compressions, and transportation.…”