By Sandy Bentley-Williams, RN, BAN, CWOCN
Medical tubes are used daily in a variety of healthcare settings and their functions can vary greatly. Endotracheal (ET), nasogastric (NG) and chest tubes are typically considered “critical tubes” because they can be necessary to save and sustain some patients’ lives. However, any tube attached to a patient can be deemed “critical” if there is risk of harm or death to the patient if it becomes dislodged.
This simple definition alone underscores the importance of properly securing critical tubes, but unfortunately there aren’t guidelines established by a standard-setting organization, nor is it a topic covered adequately during clinical training. In an effort to provide additional insight and assistance, here are a few best practices for properly selecting and applying the right adhesive for successful critical tube securement. These tips are best practices only and all techniques should follow any existing protocols of your facility.
Selecting the Right Adhesive
While some facilities may utilize a pre-made securement device for longer-term tube securement, advances in tape technology over the past few decades make it a dependable choice while offering clinicians the ability to quickly and reliably customize securement to each patient’s unique needs.
To help evaluate what medical tape is best, clinicians have to determine: 1) What type of tube you are securing, 2) Where on the patient’s body you’ll be securing it and 3) How long the tube will be in place.
When using medical tape to secure critical tubes, the most ideal adhesives are acrylate based, which have pressure sensitive adhesion that builds within the first 24 hours to provide strong, long-lasting adhesion. Acrylate adhesives come with a variety of backing options, such as paper, cotton, silk, elastic and polyester, which provide different levels of breathability and flexibility. When securing heavier tubes, clinicians should select a medical tape with a stiffer backing. If the patient is likely to experience movement or swelling at the site of securement, you might consider a tape with a backing that stretches. In situations where moisture is present, such as in isolettes or when a patient is experiencing a diaphoretic episode, it is important to choose a tape that can withstand moisture without losing adhesion.
After you’ve selected the most appropriate adhesive solution for your securement needs, it is equally important to ensure successful application.
Application Best Practices
Clinicians are challenged with securing critical tubes to various contours of the body, often in challenging conditions. To ensure proper securement application, follow these best practices:
- Prepare the skin: It’s imperative that the patient’s skin is clean and completely dry prior to applying tape. All hair should be removed and skin intact to allow the adhesives to adhere to the skin. An alcohol free barrier film can be administered to the skin prior to tape to reduce the chance of strong adhesives, and improper tape removal, causing medical adhesive-related skin injuries or MARSI.
- Apply the tape: Using the Omega technique, without pulling or stretching the tape, encircle the tape over the tubing and pinch the tape together where it meets. To maximize contact, tape can also be applied in a spiral motion down the tube. Next, secure the tape to the skin leaving a minimum of ½ to one inch of tape on each side. It’s essential that firm pressure is applied to the tape to set the adhesion. Make sure not to apply tape too close to the mucosal lining of the nose, avoid tape gaps and wrinkles that can allow moisture in, and never encircle a limb completely with tape.
- Monitor: It’s important to regularly monitor the tubes to make sure the securement isn’t too tight, putting patients at risk for medical device-related pressure ulcers, or too loose, putting patients at risk for tube dislodgement. Reposition the tube at least once daily and remember that each time you reposition the tube, you have to re-tape. It’s also helpful to mark tubing for depth and to track possible migration.
Clinicians securement selection decisions and application techniques play a major role in properly securing critical tubes and safeguarding optimal patient safety and comfort. By better understanding how to select the most appropriate adhesive for the job and applying best practices for application, clinicians can feel more confident that their patient’s critical tubes are properly secured.
Sandy Bentley-Williams, RN, BAN, CWOCN, has nearly 25 years of experience as a CWOCN, practicing in a variety of care settings. She is currently a senior technical services engineer in the Critical and Chronic Care Solutions Division at 3M. If you’d like to hear more from Sandy, she hosts a free, on-demand online training module on “Critical Tube Securement and Patient Safety” worth 1.5 CE credits through 3M’s professional educational resource, Health Care Academy.