# Total Newbie and ETI Frustration



## BigCode (Nov 23, 2010)

I am a total newbie here.  Been lurking for some time.

Thought about posting but have just never gotten around to it.  

However, had a patient extubate himself the other day in transit.  I am totally frustrated with our procedures for taping. :sad: 

I thought I would finally post and see if anyone else has had this experience. First time it has happened to me in some time.

Anyone have any advice?  Is everyone else taping or are you using those expensive disposable holder things I've see around?  We don't have any in our unit and I can't see them buying them.

Sorry if I posted this in the wrong place.  Thanks for the help. 

I look forward to posting more and will definitely continue to lurk.


----------



## TransportJockey (Nov 23, 2010)

Here, I am expected to use a tubetamer whenever I tube someone orally. I still wind up using a veiniguard and a little tape for nasal tubes though. 
Tubetamers aren't too expensive and have a built in bite block. They are pretty handy to have on hand.


----------



## Shishkabob (Nov 23, 2010)

We have tube tamers.  However, if all you have is tape, don't be afraid to make the patient a (figurative) mummy.

I'd rather get strange looks for having their lower head wrapped in tape than go to court for a 'supposed' esophageal intubation.


----------



## abckidsmom (Nov 23, 2010)

If all my agency carries for securing the tube is tape (not recommended, BTW, commercial tube holding devices are recommended), I use a nasal cannula, make a slip knot in the non-nasal cannula side, slip it over the tube and snug it up, noting the depth, then slipping the whole thing around the neck and slipping the tightener thing up till it's tight. 

This is really poorly explained, but plastic-on-dry plastic is really secure, as long as you can get the initial contact when the tube's still dry.


----------



## MrBrown (Nov 23, 2010)

Use a thomas tube holder


----------



## Aidey (Nov 23, 2010)

BigCode said:


> However, had a patient extubate himself the other day in transit.  I am totally frustrated with our procedures for taping. :sad:



How did he extubate himself? Pull it out with his hand? Move his head the wrong way?


----------



## BigCode (Nov 30, 2010)

Aidey said:


> How did he extubate himself? Pull it out with his hand? Move his head the wrong way?


He moved his head the wrong way.  Didn't pull the tube clear out, but enough that we had to reintubate and check for CO2 again. 

Talked to a fellow EMT yesterday and he said they use a holder (he wasn't sure of which one) and then when things calm down, they also apply tape to the tube and face as a precaution.  

Overall he thought the holder they used was good.  Really the only thing he has ever used. He said he would get me the name later this week when he was on shift.

Thanks everyone for the replies and support.


----------



## BigCode (Nov 30, 2010)

abckidsmom said:


> If all my agency carries for securing the tube is tape (not recommended, BTW, commercial tube holding devices are recommended), I use a nasal cannula, make a slip knot in the non-nasal cannula side, slip it over the tube and snug it up, noting the depth, then slipping the whole thing around the neck and slipping the tightener thing up till it's tight.
> 
> This is really poorly explained, but plastic-on-dry plastic is really secure, as long as you can get the initial contact when the tube's still dry.


abckidsmom,  you mentioned that taping alone is not recommended. 

Who's recommendation is that?  Department, state or other?

Perhaps I can point it out to others around here.


----------



## abckidsmom (Nov 30, 2010)

BigCode said:


> abckidsmom,  you mentioned that taping alone is not recommended.
> 
> Who's recommendation is that?  Department, state or other?
> 
> Perhaps I can point it out to others around here.



I'll have to look it up, but I thought that was a registry or ACLS recommendation.

I know that many of the agencies I've worked with teaching ACLS have had it as policy.


----------



## Aidey (Nov 30, 2010)

BigCode said:


> He moved his head the wrong way.  Didn't pull the tube clear out, but enough that we had to reintubate and check for CO2 again.
> 
> Talked to a fellow EMT yesterday and he said they use a holder (he wasn't sure of which one) and then when things calm down, they also apply tape to the tube and face as a precaution.
> 
> ...



He moved his head? Was adequate sedation present? Also, put a c-collar on the pt, it prevents a lot of the head movement.


----------



## WolfmanHarris (Nov 30, 2010)

Thomas tube restraint on all intubations and supraglottic airways.


----------



## Cawolf86 (Nov 30, 2010)

Might be a dumb question - but did you have an OPA in there? I agree on the C-Collar too.


----------



## STXmedic (Dec 1, 2010)

I'm willing to bet that if they don't want to dish out the money for "expensive" tube tamers, they probably don't want to spend money on rarely-used sedatives or paralytics... :unsure: To the OP: Have you tried putting a c-collar on the pt post-intubation? It limits a lot of that unintentional head movement.

edit: oops, didn't read the rest of your post, aidey


----------



## usalsfyre (Dec 1, 2010)

BigCode said:


> I am a total newbie here.  Been lurking for some time.
> 
> Thought about posting but have just never gotten around to it.
> 
> ...



The number one recomendation I have for you is a adaquate sedation and pain control. The number two is that commercially made tube holding devices are less than 5 bucks apiece. Number three is that if your service is too cheap to do both of these than ya'll probably don't need to be intubating (but ET tubes are far cheaper than rescue airways). 

A crapload of tape/IV tubing/the nasal canula works, but is not very defensible if something bad happens.


----------



## MrBrown (Dec 1, 2010)

WolfmanHarris said:


> Thomas tube restraint on all intubations and supraglottic airways.



Brown likes the way that you Canadians think!


----------



## WolfmanHarris (Dec 1, 2010)

MrBrown said:


> Brown likes the way that you Canadians think!



We're also required to placed an inline filter, tube extender and ETCO2 filterline (to LP15, not colormetric) on all intubations and King LT's. Confirmation of placement in three ways at placement and during moves to be documented and C-collar recommended to ensure a secure airway.


----------



## MrBrown (Dec 1, 2010)

WolfmanHarris said:


> We're also required to placed an inline filter, tube extender and ETCO2 filterline (to LP15, not colormetric) on all intubations and King LT's. Confirmation of placement in three ways at placement and during moves to be documented and C-collar recommended to ensure a secure airway.



Interesting to see you use ETCO2 on a supraglottic airway, it was being looked at on the end of an LMA here.

Man its early, Brown needs a pick me up .... 

Hmm, looks clear, no traffic, some wires at your five o'clock now, well away tho
Toronto, Medivac descending, call you agian airborne
Right Oz, all good, keep it running .... 

Yes hello Dr Brown here, helicopter emergency medical service, which way to Tim Hortons?


----------



## usalsfyre (Dec 1, 2010)

MrBrown said:


> Interesting to see you use ETCO2 on a supraglottic airway, it was being looked at on the end of an LMA here.
> 
> Man its early, Brown needs a pick me up ....
> 
> ...



Brown, over here we've gotten to where it's even used on the BVM. If EMS is providing ventilations, we've got to have waveforms to back it up. 

Wolfman, what's a tube extender? If it's something to get the weight of the BVM off the tube, please drop me a link.


----------



## TransportJockey (Dec 1, 2010)

We also use inline ETCO2 when we place combis here, as well as for ETI... I might have to play with using it on a BVM...


----------



## WolfmanHarris (Dec 1, 2010)

MrBrown said:


> I
> Yes hello Dr Brown here, helicopter emergency medical service, which way to Tim Hortons?



Just throw a rock. In my town of 70000 people we have 11. (I think, I may have missed one)



usalsfyre said:


> Wolfman, what's a tube extender? If it's something to get the weight of the BVM off the tube, please drop me a link.



I looked for a link but can't find one. When I'm back to work I'll take a look at the packaging and try to get a correct name for it. Picture an extra wide bendy straw that goes into the circuit to allow the BVM to move, be placed on the ground, etc. without yanking on the tube.


----------



## TransportJockey (Dec 1, 2010)

WolfmanHarris said:


> Just throw a rock. In my town of 70000 people we have 11. (I think, I may have missed one)
> 
> 
> 
> I looked for a link but can't find one. When I'm back to work I'll take a look at the packaging and try to get a correct name for it. Picture an extra wide bendy straw that goes into the circuit to allow the BVM to move, be placed on the ground, etc. without yanking on the tube.


Sounds almost like the flexible piece that comes in a nebulizer package... Which should actually work for that too.


----------



## usalsfyre (Dec 1, 2010)

jtpaintball70 said:


> Sounds almost like the flexible piece that comes in a nebulizer package... Which should actually work for that too.



That's what I was thinking, except it would require an adapter we don't have, and I've requested several times :angry: .


----------



## boingo (Dec 1, 2010)

We use cloth trach tape, never had a problem with it.


----------

