Impact of an Endotracheal Tube Holder to Reduce Facial Injury

Background: Data describing an endotracheal tube holder both for securing an endotracheal tube (ETT) and reducing skin breakdown compared to cloth tape or other methods of securing the ETT in adult intensive care units (ICU) are limited. Pressure injuries associated with ETTs are concerning due to increased morbidity, treatment cost, and reduced reimbursement. Having a device specific to secure an ETT may reduce variation and improve outcomes. We have used cloth tape to secure ETTs for many years at our hospital. We hypothesize that using a device designed to secure the ETT would reduce hospital-acquired pressure injuries to the mouth and face and secure the airway better than tape. Methods: The Hollister AnchorFast ETT holder was initiated on all intubated patients that met criteria in our adult intensive care units starting in August 2017. Data was retrospectively collected on number of skin injuries to the mouth/face and unplanned extubations compared to ETTs secured with 1 inch cloth adhesive tape. We collaborated with the ICU nurses to ensure that the ETT holder would be repositioned as recommended every two hours. Two data periods were analyzed, PRE - January 2016 to August 2017, POST - August 2017 to present. Results: 7,614 patients received mechanical ventilation in the adult ICU9s since January of 2016, 5,286 patients in the prior to the ETT holder (PRE) and 2328 patients during use of the ETT holder (POST). See data table for incidence of injury and unplanned extubations. Conclusions: Pressure injuries associated with the ETT had a significant decrease from 2.93% (PRE) to 1.97% (POST). Along with the reduction in skin breakdown, the number of unplanned extubations was unchanged. Future studies should investigate the quality of mouth care given when using an ETT holder versus cloth tape.