Securing Endotracheal Tubes: Suture vs. Tape

Primary Securing Method

• The American Heart Association recommends securing the endotracheal tube with tape or a commercial device to avoid compression of the front and sides of the neck, which could impair venous return from the brain, in patients requiring endotracheal intubation 1
• The American Thoracic Society suggests that tape shows superior results in most studies when properly applied for securing endotracheal tubes, with a focus on minimizing complications in critically ill patients 2

Critical Implementation Steps

• The American College of Cardiology recommends confirming proper endotracheal tube placement using clinical assessment, waveform capnography, and absence of gastric insufflation sounds before securing the tube, to ensure accurate positioning in patients undergoing mechanical ventilation 1
• The American Heart Association advises recording the depth of the tube as marked at the front teeth or gums before securing and documenting this initial position, to facilitate monitoring of tube placement in intubated patients 1
• The American Thoracic Society recommends applying tape in a manner that avoids compression of the front and sides of the neck to prevent impaired venous return from the brain, with a focus on patient safety during endotracheal intubation 1, 2

When Sutures May Be Considered

• The American Academy of Otolaryngology-Head and Neck Surgery suggests that for tracheostomy tubes, sutures should be removed within 7-10 days and preferably before discharge, unless required to secure the airway during prone ventilation, in patients with tracheostomy tubes 3

Common Pitfalls to Avoid

• The American College of Cardiology recommends never relying on sutures alone for routine endotracheal tube fixation, as this is not supported by guideline recommendations, and may increase the risk of complications in patients requiring endotracheal intubation 1, 2
• The American Heart Association advises avoiding compression of neck vessels when securing the endotracheal tube, which can impair venous return from the brain, and may lead to serious complications in critically ill patients 2

Monitoring for Deterioration

• The American College of Cardiology recommends immediately assessing the patient using the DOPE mnemonic (Displacement of tube, Obstruction of tube, Pneumothorax, and Equipment failure) if an intubated patient's condition worsens, to quickly identify and address potential complications 1, 2