NORCET 6 Prelims -2024: How to tie ET tube to adult patient to prevent bedsore?

NORCET 6 Prelims -2024

Medical & Surgical Nursing

Hard

Appeared in: NORCET 6 Prelims -2024

Explanation

The correct method, 'cheek to cheek over the ear,' uses the stable, bony structure of the head to anchor the endotracheal (ET) tube securely.
This technique distributes the tension of the ties over a wider surface area, which is crucial for preventing the development of localized pressure injuries (bedsores).
By passing the ties over the ear, direct compression on the delicate cartilage of the auricle is avoided, preventing pain, ischemia, and tissue necrosis.
This method also keeps ties away from the neck, mitigating the risk of compressing vital blood vessels like the jugular veins, which could impede cerebral venous drainage.

Option A: Placing ties directly 'on the ear' concentrates pressure on the ear cartilage, which can rapidly lead to tissue ischemia and the formation of a painful pressure ulcer.
Option C: Securing the ties 'above the ear' provides a less stable anchor point. The ties are more prone to slipping either up toward the scalp or down onto the ear, increasing the risk of accidental tube dislodgement.
Option D: Routing ties 'over the neck' is extremely dangerous. It poses a significant risk of compressing the jugular veins, which can increase intracranial pressure. It can also cause skin breakdown and discomfort.

Clinical Relevance

Nursing practice connection: Use the key finding related to Endotracheal tube fixation and prevention of pressure injuries to guide bedside assessment, documentation, and the next nursing action.
Proper ET tube securement is a fundamental nursing responsibility that directly impacts patient safety by preventing both unplanned extubation and iatrogenic pressure injuries.
Nurses must perform regular skin assessments under and around the fixation device, repositioning the tube side-to-side (per protocol) to prevent lip and oral mucosal ulcers.
What if the patient has pre-existing skin breakdown behind the ears? In this case, a commercial tube holder that avoids ear contact entirely would be the best choice. If unavailable, creative padding with skin-protective dressings would be necessary, with very frequent skin checks.

How to Approach the Question

First, identify the core of the question: it's about both securing an airway and preventing a complication (bedsores).
Analyze the options by considering basic anatomy and principles of pressure injury prevention.
Think about where pressure would be concentrated with each method. The goal is to distribute force over a large, non-sensitive area.
Eliminate options that are obviously dangerous. Tying anything around the neck ('over the neck') is a major red flag in patient care.
Eliminate options that create a direct pressure point on a sensitive structure, like cartilage ('on the ear').
Compare the remaining options ('over the ear' vs. 'above the ear') for stability. 'Over the ear' uses the curve of the head for a more secure fit, making it the superior choice.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 29-31