C-spine collar to help secure tube

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goidf

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I have heard of medics using a c-spine collar to secure he intubation tube. I am talking about medical cases with no trauma, he collar is only being used to secure the tube. does anyone actually do this? does anyone have any reference material for this?
 
Yes I favor this as tool when moving a patient from a cumbersome location.
 
It's part of our intubation protocol. Once the patient has been intubated, a c-collar is placed to minimized neck flexion which may dislodge the tube. Don't know how legit it is, but every little bit helps, right?
 
can you send me a copy/link of that protocol?
I'm looking for references in writing....
 
I try and do this on all my Intubation and even when I place a supraglottic device. It just helps keep thing inline and reduce any movement that could compromise the airway.

At my previous service in north texas, our protocol was that "IF POSSIBLE" patients who are intubated should be placed on a backboard (for ease of movement) have a c-collar placed and be secured with CID or head bead. Nobody ever did the CID.

Sorry I don't have any reference documents to send you.
 
We do the same, it's the standard here. Not sure if it's a made up standard however.
 
It probably does more to secure the tube than it does to secure the c spine.
 
Heh, I can see why you are asking for text. I am having a hard time finding text on this too.

I think prior to starting my internship in Santa Clara County, CA, there was an EMS update class for 2014 where the medical director Eric Rudnick had several power point presentations on airway management, pediatric trauma, and strokes. He made an audio recording to go with each slide and it was available online to anyone that worked for the contracted 911 provider. I think that's when I was introduced to the idea of putting on a c-collar on the patient after they are intubated to prevent extubation (and he mentioned bronchial intubation if the patient's head is flexed). I briefly tried going through the power point, but couldn't find it in text or him flat out saying it in the audio. Perhaps it's because I wasn't willing to watch the whole thing for an hour and a half again, lol.

I tried looking through Santa Clara County's protocols for it, but couldn't find anything that flat out says it. I couldn't find it in the current protocol, but in the old version of it. In the (older) protocol, it only mentions it for pediatric intubation on page 4 and 5.

Equipment
See adult equipment above.
• Backboard, cervical collar or other immobilization device to limit neck extension

Procedure
...
• Use immobilization device to prevent neck extension and tube dislodgement.
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Advanced Airway Management - Adult/Pediatrics (M01) prior to revision of protocol.

I tried looking online for more on it.

I found an article on EMS World that mentions it.

10. Secure the tube
Once tube placement is confirmed it must be secured with a commercial device or tape. Never rush this step and pay close attention to details. If vomit or blood is near the patient’s mouth, wipe it off before the tube is secured. A cervical collar can help keep the tube in place by limiting head movement during patient movement.
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EMS Airway Management

Found one study from NCBI here.

That's about as much effort as I am gonna put into research this tonight.

Maybe you could try e-mailing Eric Rudnick if you can find his e-mail on the Santa Clara County EMS website?
 
Don't know about all that, but I do know that forming the C-Collar, setting it on the floor/bed/whatever (oriented with the opening top and bottom) and then placing the back of the patient's head on it puts the head in a virtually perfect sniffing position for intubating.

Don't believe me? Try it the next time you're practicing on a mannequin.
 
In all honesty, if you actually have to use a c-collar to help secure an ET tube, there are some other problems that need to be addressed. Not that it's a bad idea at all, just that it really shouldn't be needed.

Either your securing of the ET tube is piss poor, you (and the people that you are responsible for) are being way to rough in moving patients, or the trucks you ride in have shocks that are non-existent.

Can't really do anything about the last one, and sometimes there are circumstances where moving an intubated patient is not the smoothest evolution (but there are other ways to overcome that), but the first one is definitely on the individual provider.

I suppose I'm just a fan of actually learning how to do things correctly, instead of using gimmicks to make up for poor performance.
 
For a few years now, the trends in emergency airway management have been towards taking all sorts of precautions in order to maximize the chances of success and minimize the risk of harm to the patient during intubation. If we aren't going to refer to VL, bougies, and pre-intubation checklists as "gimmicks" meant to "make up for poor performance", then I'm not sure why we'd view precautions intended to help prevent potentially catastrophic post-intubation complications that way.

Securing the ET tube properly does nothing to prevent tube migration due to head flexion or extension......in fact, it increases the chance of it, especially in pediatrics, because it ensures that the distal tip of the ETT will move every time the head moves. Only restriction of head and neck motion does so. I don't know that using a c-collar has ever been proven to reduce the risk of inadvertent extubation, but it makes good sense to me.

In medicine we take all sorts of precautions that wouldn't be necessary if everyone were perfect all the time. But even if you are perfect, other people and events beyond your control will still be a factor.
 
Remi said:
For a few years now, the trends in emergency airway management have been towards taking all sorts of precautions in order to maximize the chances of success and minimize the risk of harm to the patient during intubation. If we aren't going to refer to VL, bougies, and pre-intubation checklists as "gimmicks" meant to "make up for poor performance", then I'm not sure why we'd view precautions intended to help prevent potentially catastrophic post-intubation complications that way.

Securing the ET tube properly does nothing to prevent tube migration due to head flexion or extension......in fact, it increases the chance of it, especially in pediatrics, because it ensures that the distal tip of the ETT will move every time the head moves. Only restriction of head and neck motion does so. I don't know that using a c-collar has ever been proven to reduce the risk of inadvertent extubation, but it makes good sense to me.

In medicine we take all sorts of precautions that wouldn't be necessary if everyone were perfect all the time. But even if you are perfect, other people and events beyond your control will still be a factor.
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There is a big difference between using VL, a bougie, or similar device for difficult and anticipated difficult airways and using them on each and every airway because the provider isn't skilled. I suppose I should be clear and mention that there is a difference between using something and simply having it at hand in case it's needed. There is also a difference in using VL for every airway because the provider believes it is the superior method, versus because the provider isn't skilled at DL. The same holds true for a checklist; using it to make sure that everyone is aware of what is going on to increase safety and team dynamics is different than using one because the provider isn't skilled at the same (this isn't meant to take away from using a checklist at all for any reason; for inexperienced and experienced providers it is a very handy thing to do).

If motion and movement of the patient is such that a c-collar needs to be placed every time then yes, unless there are some extenuating circumstances, it is being used as a crutch, because the provider isn't properly doing their job. It's not that it is a bad idea, it's just that (barring those extenuating circumstances) it shouldn't be really needed.
 
Even if it were a "crutch", I don't see how one can argue that placing a c-collar on intubated patients isn't a good idea. A tube coming dislodged has little to do with the medic's skills at placing a tube, nor managing that patient, since a bunch of other people will be handling and bagging the patient as well.

There isn't even a potential downside to doing it, since the collar is not potentially harmful to the patient and it only takes maybe 10 seconds to apply.

It isn't in our protocols, but it was in my ITLS textbook.
 
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triemal04 said:
In all honesty, if you actually have to use a c-collar to help secure an ET tube, there are some other problems that need to be addressed. Not that it's a bad idea at all, just that it really shouldn't be needed.

Either your securing of the ET tube is piss poor, you (and the people that you are responsible for) are being way to rough in moving patients, or the trucks you ride in have shocks that are non-existent.

Can't really do anything about the last one, and sometimes there are circumstances where moving an intubated patient is not the smoothest evolution (but there are other ways to overcome that), but the first one is definitely on the individual provider.

I suppose I'm just a fan of actually learning how to do things correctly, instead of using gimmicks to make up for poor performance.
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Thank you for some common sense.

We never put C-collars on as a way of securing ETTs anywhere in the hospital. Tape it/secure it so it doesn't come out - period. Our respiratory folks take off the tape we put on in the OR and put on a fancy adhesive thing with a tube clamp and a tie that goes all the way around the neck. It works great. We move intubated patients all over the place - bed to OR table, bed to CT, turned prone on the OR table, turning them on their side in the ICU q2hr, etc. C-collars don't prevent anyone from somehow yanking on the tube, which is 99.9% of the reason tubes come out accidentally.

Using a C-collar sounds like a good idea, and it probably doesn't hurt anything, so it's hard to argue against it. I just don't think it helps anything. Better to learn how to tape a tube in properly so it doesn't come out.
 
Lung sounds should be reconfirmed before and after each transition regardless. Now that everyone has ETCO2, there's even less room for an accidental extubation to go unnoticed. A few years back PHTLS said that somewhere around 30% of prehospital intubations were iatrogenically extubated at some point.

I don't know however, how many of those tubes were "properly taped" and whatnot, so I can't intelligently debate if thats a factor or not. But I do think that a tube buys a c collar. It takes 5 seconds and some forethought. The risk/benefit ratio is too far apart to not do it.
 
jwk said:
Better to learn how to tape a tube in properly so it doesn't come out.
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I think you guys are really missing the point.

Of course everyone should know how to properly tape a tube and transfer a patient. That's a given. No one is saying "hey bro - if you are having trouble with your tubes getting pulled, just start using a c-collar and your accidental extubations will go way down".

The c-collar is just a small extra measure of precaution - not unlike putting an extra piece of tape on the IV before you leave the ICU for the helicopter, or having that extra syringe of propofol already drawn up.
 
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Obviously people who drive vehicles use a seatbelt due to the fact they are a poor driver and lack the proper skills needed to safely drive somewhere. A seatbelt serves as a crutch when safe driving skills are lacking.
 
I do not see much comparison to the hospital here. Patients get moved a lot in surgery, by a trained group of people who are used to moving intubated patients. The volunteer firefighters that are not even first responders? Not so much. I'm not sure how it was ever construed as a crutch, it's just a way to help.

Also the bougie comment caught my eye. In school we were taught to use the bougie 100% time if that's what we found that worked. ABout half of our ED physicians started using it on most cases this year after attending some sort of magical training. But it's a crutch right, because not everyone learned something that way?
 
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