Oral tracheal tube taping - PICU SOP

• Check position of ETT on recent CXR
• Consider any drug requirements 
  • Analgesia
  • Sedation
  • Paralysis
• Discuss plan with clinical team
• Airway equipment as intubation setup
• Cut trouser legs (tragus to tragus length)

• Team brief & allocate roles
• Confirm drug(s) and doses to be used
• Clinical team and Nurse in Charge aware
• Previous grade of intubation (WAIT chart)
• Check ETT length at mouth
• QRS tone on
• Face mask & Yankeur suction at head of bed
• BP attached, every 1 minute, not on limb with SpO2 or IV access
• Pre-oxygenate (unless balanced circulation) & optimise ventilator settings
• Consider suctioning ETT prior to re-taping
• Aspirate NGT and reposition NGT tape
• Administer drug(s) as above

• If replacing old tapes, loosen with AppeelTM, avoiding the eyes
• Remove old tapes with assistant holding ETT
• Check skin for any pressure damage
• Ensure ETT position correct and note length
• Deflate cuff only if repositioning ETT

• 1st tape starts SAME side to tube
• Lower trouser leg under lower lip
• Follow facial contours closely

• Wrap upper trouser leg over the top of the tube
• Wrap neatly and avoid crumpling

• Wrap around tube twice
  (Include cuff tubing)
• 50% overlap each turn
• Fold edge over end of trouser leg so it’s easy to remove

• 2nd tape starts SAME side to tube
• Upper trouser leg across upper lip
• Lower tape wraps under tube
• Wrap twice, 50% overlap, fold edge
• (Confirm tube cuff pressure)

DOCUMENT

• CiS event
  
  
• Cuff pressure on CiS
  
  
• Any pressure areas?
  
  
• Update WAIT chart
  
  
• PACS ‘sticky note’
  (if tube repositioned)

DEBRIEF

• Team debrief
  
  
• Tissue viability referral?
  
  
• Ventilator settings plan