Endotracheal Tube and Oral Care

1.  Perform hand hygiene and don personal protective equipment.
2.  Ensure that endotracheal tube is connected to the ventilator using a swivel adapter.
3.  Support the endotracheal tube and tubing as needed.
4.  If suctioning is clinically indicated, hyperoxygenate and suction endotracheal tube.
5.  Loosen and remove old tape and ties.
6.  If patient is nasally intubated, clean around endotracheal tube using saline-soaked gauze or cotton swabs. Proceed to step 9.
7.  If patient is intubated orally, remove bite-block or oropharyngeal airway (acting as bite-block). Proceed to step 9.
9.  Perform oral hygiene, using pediatric or adult (soft) toothbrush, at least twice a day. Gently brush patient's teeth to clean and remove plaque from teeth.
10. In addition to brushing twice daily, use oral swabs with a 1.5% hydrogen peroxide solution to clean mouth every 2-4 hours. With each cleansing, apply a mouth moisturizer to the oral mucosa and lips to keep tissue moist.
11. Suction oral cavity/pharynx frequently.
12. Move oral tube to the other side of the mouth. Replace bite-block or oropharyngeal airway (to act as bite-block) along the endotracheal tube if necessary to prevent biting.
13. Ensure proper cuff inflation using minimum leak volume or minimum occlusion volume.
14. Reconfirm tube placement and note position of tube at teeth or naris.
15. Secure the endotracheal tube in place (according to institutional standard).
16. Document in patient record.