|LETTERS TO EDITOR
|Year : 2019 | Volume
| Issue : 3 | Page : 400-401
Endotracheal tube fixation: Still a dilemma
Abhishek Nagarajappa, Manpreet Kaur, Anupam Samanta, Abhay Tyagi
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||3-Sep-2019|
Dr. Manpreet Kaur
All India Institute of Medical Sciences, E19 Ayurvigyan Nagar, New Delhi - 110 049
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nagarajappa A, Kaur M, Samanta A, Tyagi A. Endotracheal tube fixation: Still a dilemma. J Anaesthesiol Clin Pharmacol 2019;35:400-1
|How to cite this URL:|
Nagarajappa A, Kaur M, Samanta A, Tyagi A. Endotracheal tube fixation: Still a dilemma. J Anaesthesiol Clin Pharmacol [serial online] 2019 [cited 2021 May 17];35:400-1. Available from: https://www.joacp.org/text.asp?2019/35/3/400/265931
Endotracheal tube (ETT) displacement can become a catastrophic event in surgeries where in anesthesiologists are away from the surgical field, and where easy access to the ETT is difficult. Hence, the fixation of endotracheal tube by securing adhesive tapes is of utmost importance as it not only provides effective ventilation but also minimizes complications due to re-interventions., The desired qualities of these tapes are good quality adhesive material, water-resistant nature, non-toxic, non-irritant, non-allergic material, easy availability and being economical.
We compared the adhesiveness of 6 different adhesive tapes used in our institute ex-vitro, after wetting them with antiseptic solution.
TAPE 1: Cloth-based woven non-elastic adhesive tape [Porouspore, Sterimed Healthcare Technologies LLC, Florida]
TAPE 2: Silk-based adhesive tape [Durapore, 3M]
TAPE 3: Silicone gel-based water resistant adhesive tape [STERIPORE, Sterimed Healthcare Technologies LLC, Florida, USA]
TAPE 4: Micro-porous non-woven acrylic fabric adhesive tape [Surgi-pore, surgical tape]
TAPE 5: Cloth-based woven elastic adhesive tape [Sterimed Elastic Adhesive Bandage BP]
TAPE 6: Cloth-based woven elastic adhesive tape covered with transparent IV film dressing [Sterimed Elastic Adhesive Bandage BP + Tegaderm, 3M India Ltd].
All six tapes of similar dimensions were adhered to a particle board. [Figure 1](a) and then were draped wet using equal quantity of Povidone Iodine antiseptic solution [Microshield PVP-S, Alliance Formulations, India]. [Figure 1](b) routinely used for sterile draping of surgical site. We compared adhesiveness, ease of removal and ability of reapplication after an interval of 4 hours [Figure 1](c).
|Figure 1: (a) Tape 1-6 fixed to a particle board; (b) Tapes 10 minutes after wetting with antiseptic solution; (c) Tapes seen 4 hours after wetting with antiseptic solution; (d) Tapes seen after applying force for removal|
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We observed that ease of removal was: 1> 5> 2> 3> 4> 6. [Figure 1](d). Cloth-based non-elastic adhesive tape [TAPE 1] came off on its own within 30 minutes of wetting and lost most of its adhesiveness. Cloth-based woven elastic adhesive tape [Tape 5] came off easily after applying minimal force but retained adhesiveness to be reapplied. However, Tape 5 with Tegaderm covering [Tape 6] remained relatively dry due to the water resistant nature of Tegaderm, and hence did not peel off even after 4 hours of wetting with antiseptic solution. Tapes 2, 3 and 4 were relatively better adhered to the surface and difficult to remove.
Adhesiveness after reapplication of the same tapes was best seen with Tape 3 followed by Tapes 6, 4 and 2 respectively. We also compared the cost per patient of each tape to know their cost effectiveness. Cost per person for 2 strips of 1.25 cm × 15 cm dimensions were Rs 0.36, 0.72, 23.667, 0.094, 0.45 and 17.456, for tapes from 1-6, respectively. Thus, tape 4 was the cheapest of the lot and Tape 3 the costliest [Table 1]. Their cost benefit ratio for the hospital is yet to be determined.
Cloth-based woven elastic adhesive tape covered with transparent IV film dressing and micro-porous non-woven acrylic fabric adhesive tape are the reasonably good options for tube fixation. The above observations are based upon the adhesiveness to an ex-vitro surface.
However, the major limitation of this observation is that the ex-vitro surface cannot match the structural properties of the human skin surface completely.
We cannot comment on the clinical superiority of one tape over the other without any randomized controlled trial. Thus, there is a large void in available literature regarding endotracheal tube fixation with adhesive tapes, and this study hence provides a scope for further randomized controlled trials.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lai M, Inglis GD, Hose K, Jardine LA, Davies MW. Methods for securing endotracheal tubes in newborn infants. Cochrane Database Syst Rev 2014:CD007805. doi: 10.1002/14651858.CD007805.pub2.
Assi P, Quiroga L, Gerold K, Caffrey J. Endotracheal tube fixation in patients with facial burns, What are the options? Eplasty. 2018 Sep 28;18:ic19. eCollection 2018.