How to tie ET tube to adult patient to prevent bedsore?

NORCET 6 Prelims -2024

Medical & Surgical Nursing

Medium

Appeared in: NORCET 6 Prelims -2024

Explanation

Passing the ties over the ear distributes pressure across a wider, more stable area of the head, avoiding direct compression of the ear cartilage.
This technique securely anchors the tube while minimizing the risk of auricular (ear) pressure injuries, which can develop quickly in critically ill patients.
The path from the cheek, over the ear, and to the back of the head provides a stable and anatomically sound method for fixation, as illustrated in the provided image.

Option A: Placing ties directly 'on the ear' concentrates pressure on the cartilage, leading to ischemia and a high risk of painful pressure sores.
Option C: Tying 'above the ear' without using the ear as a superior anchor is less secure. The ties can easily slip down onto the ear, causing pressure, or become loose, which increases the risk of accidental extubation.
Option D: Tying 'over the neck' is extremely dangerous. It can compress the jugular veins, which impedes cerebral venous drainage and can increase intracranial pressure. It also creates a high risk for severe pressure injuries on the neck.

Visual 1: Diagram illustrating the correct path for ET tube ties: from the mouth, across the cheeks, over the top of the ears, and secured at the back of the head.
Visual 2: Infographic showing common pressure points to check in an intubated patient, including the corners of the mouth, nares, ears, and back of the head.
Visual 3: Image comparing a properly secured ET tube using ties versus a commercial securing device.

Clinical Relevance

Nursing practice connection: Use the key finding related to Endotracheal Tube Fixation and Pressure Injury Prevention to guide bedside assessment, documentation, and the next nursing action.
Nurses must perform and document skin assessments at least every 2-4 hours on patients with an ET tube, specifically checking the cheeks, lips, nares, and behind the ears for redness or breakdown.
The ET tube should be repositioned from one side of the mouth to the other according to facility protocol (e.g., every 8-12 hours) to prevent lip and oral mucosal injury.
Many facilities in India now use commercially manufactured ET tube holders, which are designed to standardize fixation and reduce the risk of pressure-related complications compared to cloth ties.

How to Approach the Question

First, identify the primary goal of the question: to secure the ET tube while actively preventing pressure sores ('bedsores').
Next, analyze each option by visualizing the path of the tie and the anatomical structures it would press against.
Eliminate options that place direct pressure on high-risk, sensitive areas (like the ear cartilage) or are inherently dangerous (like encircling the neck).
Evaluate the remaining options for both security (preventing tube movement) and safety (pressure distribution).
The image provided is a key clue, visually demonstrating the correct technique of passing the tie over the ear.
Select the option that best balances secure fixation with the principles of pressure injury prevention.

Concept Tested & Keywords

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