Securing Endotracheal Tubes

Introduction to Securing Methods

Tape or a commercial tube holder should be used to secure endotracheal tubes (ETTs), with tape showing superior results in most studies when properly applied, according to the American Thoracic Society 1, 2

Always confirm proper ETT placement before securing using clinical assessment, waveform capnography, and chest X-ray, as recommended by the American Heart Association 4, 5
Record and document the depth of the tube at the teeth or gums before securing, as suggested by the American College of Chest Physicians 3
Re-verify tube position after securing, during transport, and each time the patient is moved, according to the American Heart Association 4, 5

Patient movement is the most important factor associated with unplanned extubation, with an increased risk when physical restraints are used (OR = 3.11), as reported by the Society of Critical Care Medicine 1, 2
Most unplanned extubations occur when the caregiver is not at the bedside, highlighting the need for continuous monitoring, according to the American Association for Respiratory Care 1, 2

For patients receiving neuromuscular blocking agents, deep sedation should be maintained to reduce the risk of unplanned extubation, as recommended by the American Society of Anesthesiologists 1, 2
If a patient's condition deteriorates after intubation, consider the DOPE mnemonic: Displacement of tube, Obstruction of tube, Pneumothorax, Equipment failure, as suggested by the American Heart Association 5, 6

Compression of neck vessels when securing the ETT can lead to impaired venous return from the brain, as warned by the American College of Physicians 3
Failure to maintain continuous monitoring of ETT position with waveform capnography can increase the risk of unplanned extubation, according to the American Thoracic Society 3
Relying solely on physical restraints may increase the risk of unplanned extubation, as reported by the Society of Critical Care Medicine 1, 2
Failure to re-verify tube position after patient movement or transport can lead to unplanned extubation, highlighting the need for regular checks, according to the American Heart Association 4, 5