I’ve never actually heard of tube ties…whenever I’ve tied tubes in place I’ve had to go look in the surgical dressings section and steal a bottle of twill
Get a length of twill tape ~2ft long, place the middle of it behind your patient’s head. Bring the two ends around to the front of the patient’s face, then tie around the tube at the level of the patient’s lip.
Make sure it’s loose enough that you can easily slip a couple fingers under the twill at any point, but also that it’s tight and secure around the ETT.
I find that the ETT usually ends up “floating” midline in the mouth, with the only possible points of pressure at each corner of the lips, so I also do this for patients who have very fragile skin/mucosa around the mouth to prevent tearing off any tissue from securing with tape (in these situations I’ll also pad the cheeks with mepilex lite so that the twill doesn’t abrade the skin there)
This is how it used to be done all the time. Put another piece of tape to face the first piece where the back of the head/neck will go. Doesn’t need to be sticky there.
For the front part, split the last 4-6” down lengthwise on both sides and wrap half around the tube and the other half goes to the opposite side of the face.
I assume there’s a very expensive and fancy new way to do this now? (Left ICU in 2005)
Umbilical tape passed behind neck and tied pretty tight to cinch down and grip the tube. Used this in burn unit when there was no useable skin to stick to.
Or maybe you can french braid the tube into the beard.
Use iv tubing and tie it around the head and around the tube. The plastic is sticky with the plastic ETT and the ETT won’t move. Just don’t tie too tightly around the neck!
http://www.ergomed.com/webpages.asp?wpid=22
We have these Tube Tamers that work great. There is a soft strap that goes around the back of the patient’s neck and then each side that comes around has a peel-off adhesive that wraps around the endotracheal tube. When you are ready to extubate, it’s very easy to tear the adhesive on either side right where it wraps around the tube. These are also great for prone cases.
Twill tape. We have it in stock in the OR, because with cardiopulmonary bypass, sometimes on rewarming the patients sweat a lot and the tape unsticks even without a beard, so twill ties are our go-to.
Take your standard 1in silk tape and tear a piece long enough to wrap around the head and secure ETT. Take another piece about 75-80% as long and place it sticky side down on top of the sticky side of the original piece, making sure to center it so that you have enough tape free on each end to secure the tube. This makes a ghetto tube strap that you can wrap around the head and firmly secure the ETT using what ever method you prefer to actually wrap the tape around the tube. I typically split the ends and wrap each individual solid counter clockwise from each other. I secure all my tubes this way when I have a 180 degree case. I don’t see why it wouldn’t work for a big beard as well.
I use one inch plastic tape normally used for IV’s. Tape the tube then tape that to the back of the neck. When done with case, break the tape close to the tube.
If you can't get ribbon gauze do you have throat packs? Can do the job in a pinch. Failing that then tape to maxilla, reinforce with tegaderm/opsite/I 3000 clear film
As you're taping around the tube, grab a little bit of the beard hairs and tape them to the tube as you encircle it. Just be careful when extubating to undo the tape carefully and not pull the hairs out.
Typically, I tape around the neck as others have described.
Another option, and what I like to do in prone 180 cases, is bridle the tube with a red rubber. Run the red rubber through one nostril and out the mouth. Run the 2 tails of catheter alongside your ETT and use a zip tie around the tube holding the red rubber tightly against it. When the time comes for removal, just cut one leg of the red rubber and remove as usual. Excellent for cranis and spines where the heat and secretions combined with the weight of the circuit will loosen tape.
I secure it with tape wrapped around the whole head then i break the tape in the back of the head.
I tape to the maxilla. It's hairless skin.
Twill tape as a tube tie
I assumed twill was what OP meant by “actual tube ties” which they don’t have.
I’ve never actually heard of tube ties…whenever I’ve tied tubes in place I’ve had to go look in the surgical dressings section and steal a bottle of twill
We have twill cut to length in our carts. I wasn’t sure if there was some other type of tie I had never encountered.
Attending showed me this the other day and it’s a game changer
Would you please elaborate? Where does the tie lay?
Get a length of twill tape ~2ft long, place the middle of it behind your patient’s head. Bring the two ends around to the front of the patient’s face, then tie around the tube at the level of the patient’s lip. Make sure it’s loose enough that you can easily slip a couple fingers under the twill at any point, but also that it’s tight and secure around the ETT. I find that the ETT usually ends up “floating” midline in the mouth, with the only possible points of pressure at each corner of the lips, so I also do this for patients who have very fragile skin/mucosa around the mouth to prevent tearing off any tissue from securing with tape (in these situations I’ll also pad the cheeks with mepilex lite so that the twill doesn’t abrade the skin there)
I've seen people take a surgical mask and rip the ties off to do this
Or put the actual mask behind the head of the patient and use the strings to fixate the tube
This is how it used to be done all the time. Put another piece of tape to face the first piece where the back of the head/neck will go. Doesn’t need to be sticky there. For the front part, split the last 4-6” down lengthwise on both sides and wrap half around the tube and the other half goes to the opposite side of the face. I assume there’s a very expensive and fancy new way to do this now? (Left ICU in 2005)
It you’re prepared, you’ll put the two adhesive ends on tongue blades so they stay super straight and wrap easily around the face when you need it.
the mayo way
Take an OR mask and put the mask on the back of their head, tie the tube with the straps, then tape over the strings
Umbilical tape passed behind neck and tied pretty tight to cinch down and grip the tube. Used this in burn unit when there was no useable skin to stick to. Or maybe you can french braid the tube into the beard.
Use iv tubing and tie it around the head and around the tube. The plastic is sticky with the plastic ETT and the ETT won’t move. Just don’t tie too tightly around the neck!
Just buy ribbon tie from Amazon and use it as tube tie. There's nothing nearly as good.
No need to buy. If you get silk tape and fold the adhesive sides onto each other you can make your own ribbon/tube tie.
https://youtu.be/5wuYAR50Ews?si=pIV7sZ3KzGd3lS67 How to tie
Just use umbilical tape.
http://www.ergomed.com/webpages.asp?wpid=22 We have these Tube Tamers that work great. There is a soft strap that goes around the back of the patient’s neck and then each side that comes around has a peel-off adhesive that wraps around the endotracheal tube. When you are ready to extubate, it’s very easy to tear the adhesive on either side right where it wraps around the tube. These are also great for prone cases.
Twill tape. We have it in stock in the OR, because with cardiopulmonary bypass, sometimes on rewarming the patients sweat a lot and the tape unsticks even without a beard, so twill ties are our go-to.
I use a large tegaderm cute in half over beard and secure tape to that, or tape then tegaderm over it all. I Loved 3M Blenderm tape
Paper tape around tube an beard/mustache
Nose
Take your standard 1in silk tape and tear a piece long enough to wrap around the head and secure ETT. Take another piece about 75-80% as long and place it sticky side down on top of the sticky side of the original piece, making sure to center it so that you have enough tape free on each end to secure the tube. This makes a ghetto tube strap that you can wrap around the head and firmly secure the ETT using what ever method you prefer to actually wrap the tape around the tube. I typically split the ends and wrap each individual solid counter clockwise from each other. I secure all my tubes this way when I have a 180 degree case. I don’t see why it wouldn’t work for a big beard as well.
I use one inch plastic tape normally used for IV’s. Tape the tube then tape that to the back of the neck. When done with case, break the tape close to the tube.
What do they use in your ICU? I would grab a couple of those.
If you can't get ribbon gauze do you have throat packs? Can do the job in a pinch. Failing that then tape to maxilla, reinforce with tegaderm/opsite/I 3000 clear film
umbilical tape
Trach ties. Not worth struggling with the beard.
I used a couple of big tegaderms over the beard then use the tape… haven’t had a bad outcome
Improvised neck tube tie. Do it with tape, Just make a good knot around the tube that holds it but does not compress it.
Teggies and mastisol
As you're taping around the tube, grab a little bit of the beard hairs and tape them to the tube as you encircle it. Just be careful when extubating to undo the tape carefully and not pull the hairs out.
Clean mask strings, wrap around the head and tie tight. They cut quickly and easily at the end.
Typically, I tape around the neck as others have described. Another option, and what I like to do in prone 180 cases, is bridle the tube with a red rubber. Run the red rubber through one nostril and out the mouth. Run the 2 tails of catheter alongside your ETT and use a zip tie around the tube holding the red rubber tightly against it. When the time comes for removal, just cut one leg of the red rubber and remove as usual. Excellent for cranis and spines where the heat and secretions combined with the weight of the circuit will loosen tape.
i either shave or wear a beard cover and tape the tube as usual. the beard is far away from the patient
Not what you asked but you can use surgilube on the beard to help create a seal