Endotracheal Tube Care

1.  Place towel over chest of patient in supine or semi-Fowler position. Perform hand hygiene. Apply face shield if indicated.
2.  Administer endotracheal, nasopharyngeal, and oropharyngeal suction. Connect oral suction catheter to suction source.
3.  Prepare method of securing ET tube.
4.  Tape method. Cut tape long enough to encircle patient's head from naris to naris plus 6 inches. Lay tape adhesive-side up on bedside table. Cut and lay 3 to 6 inches of tape, adhesive sides together, in center of long strip to prevent tape from sticking to hair.
5.  Commercial device. Set device aside with head guard in place and Velcro strips open.
6.  Apply gloves. Instruct helper to put on gloves and hold ET tube firmly at patient's lips or naris. Note number marking on ET tube at gum line.
7.  Remove old tape or device.
8.  Tape. Carefully remove tape from ET tube and patient's face. If tape is difficult to remove, moisten with (soapy) wet washcloth, water, or adhesive tape remover.
9.  Commercial device. Remove Velcro strips; remove ET tube holder from patient.
10. Remove secretions or adhesive from patient's face. Use adhesive remover if needed.
11. Remove oral airway or bite-block, if present, and place on towel.
12. Clean mouth, gums, and teeth opposite ET tube with non–alcohol-based mouthwash solution and 4 x 4 inch gauze, sponge-tipped applicators, or saline swabs. Brush teeth as indicated. If necessary, administer oropharyngeal suctioning. Oral ET tube only: Move ET tube to opposite side or center of mouth. Do not change tube depth.
13. Repeat oral cleaning, as in step 9, on opposite side of mouth.
14. Clean face and neck; then rinse and dry. Shave male patient as necessary.
15. Using clean 2- x 2-inch gauze, dot skin protectant or liquid adhesive on upper lip (oral ET tube) or across nose (nasal ET tube) and cheeks to ear. Let dry completely.
16. Secure ET tube.

Tape method
Slip tape under patient's head and neck, adhesive side up. Center tape so that double-faced tape extends around back of neck from ear to ear.
On one side of face, secure tape from ear to naris (nasal ET tube) or over lip to ET tube (oral ET tube). Tear remaining tape in half lengthwise. Secure bottom half of tape across upper lip (oral ET tube) or across top of nose (nasal ET tube) to opposite ear. Wrap top half of tape around tube at least two times. Gently pull other side of tape and secure it to opposite side of face and ET tube.
Commercial device

Thread ET tube through opening. Be sure that pilot balloon is accessible.
Place strips of ET holder under patient at occipital region of head. Verify that ET tube is at established depth, using lip or gum line marker as a guide.
Attach Velcro strips at base of patient's head. Leave 1 cm (½ inch) slack in strips. Verify that tube is secure, does not move, and creates no pressure areas.
Clean oral airway in warm soapy water; rinse well. Remove crusted secretions with hydrogen peroxide. Rinse with mouthwash. Shake off excess water. Reinsert oral airway and secure with tape.
Discard or store used items appropriately. Reposition patient. Perform hand hygiene.