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62.5% agreed/strongly agreed tape is a causative factor in facial HAPUs.
50.1% agreed/strongly agreed the stabilizer is effective in preventing facial HAPUs.
59.4% agreed/strongly agreed a commercial ETT stabilizer facilitated tube repositioning and inspection.
Authors: Debra Beauchaine, MN, ANP/GNP-BC, CWCN, COCN-AP; Charez Norris, BAS, RRT Background: Results from our Phase I study on device-related, hospital-acquired pressure ulcers (HAPU) indicated a need for collaboration with respiratory therapy to decrease HAPU related to endotracheal tubes (ETT) and tape securement.
Purpose: 1) To decrease incidence of device-related HAPU in CCU by using a commercial ETT stabilizer and 2) to identify attitudes of Registered Nurses (RNs), and Respiratory Therapists (RTs) regarding change from tape to commercial stabilizer.
Method: A descriptive quasi-experimental intervention study was implemented. An anonymous three-question, semi-structured qualitative survey using SurveyMonkey was sent to every CCU RN and RT for 10 days prior to study intervention. Then for 2 months, a commercial adjustable ETT stabilizer with an adjustable head strap was used on all CCU patients intubated for greater than 48 hours. The RT educator randomly audited 3-4 patients/week for a total of 29 audits. The same survey was distributed post intervention to CCU RNs and RTs.
Medical Device Related HAPUsFacial HAPU: 1 patientNo Facial HAPUs: 28 patients
Phase II of A Multi-Phase Interdisciplinary Study Aimed at Reducing Endotracheal Tube Device-Related Hospital Acquired Pressure Ulcers in CCU Patients
Results: One upper lip deep tissue injury was found for a 3.4% incidence rate. The RT, RT educator and Wound Care NP determined incorrect application technique was likely cause of injury.
Conclusion: A commercial, adjustable ETT stabilizer can be effective in decreasing, but not necessarily eliminating, device-related HAPU. Education and reinforcement of correct application technique are necessary.
Next Steps: Replication of this study in ICU/Level I Trauma unit.
References: Black J, Cuddigan J, Walko M, et al. (2010). Medical device related (MDR) pressure ulcers in hospitalized patients. International Wound Journal, 7(5):358-365.
Shimizu T, Mizutani T, Yamashita S, et al. (2011). Endotracheal tube extubation force: adhesive tape versus endotracheal tube holder. Respiratory Care, 56(11):1825-1829.
Weng. (2008). The effect of protective treatment in reducing pressure ulcers for non-invasive ventilation patients. Intensive & Critical Care Nursing, 5:295-299.
32 RNs/RTs completed the post survey
JCL.com
Contacts: Debra Beauchaine, MN, ANP/GNP-BC, CWCN 602-870-6060, ext. 1178 [email protected]
Charez Norris, BAS, RRT 602-870-6060, ext. 4534 [email protected].
