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A stitch in time saves nine. But not all neonatal units believe in this saying and use different methods to secure oral endotracheal tubes in neonates who require ventilatory support. Success in stabilising a premature infant is best achieved by least intervention and good ventilatory support. A stable oral endotracheal tube will help. A naso-oral endotracheal tube is extremely easy to stabilise; however, stabilisation is not routinely performed in the United Kingdom.
Three commonly used methods are: (a) stitching the tube to a plastic flange; (b) fixing a premeasured and cut tube in a flange with adhesive tape; (c) fixing a premeasured and cut tube into a tight fitting flange. In all three methods, the tube is secured by tying it to the baby’s hat.
Normally, weight or foot length is used to determine endotracheal tube size, and this is quite reliable. However, head movement, suctioning, and patient care can all cause instability and displacement of the tube.1,2 If the tube is too short, there will be ineffective ventilation. If the tube is too long, it may collapse resulting in selective ventilation. A precut tube is difficult to manipulate if the positioning is not satisfactory. This is not a major problem in a stitched tube. There are pros and cons to each method.
There are no comparative studies from the United Kingdom to evaluate the benefits and disadvantages of each method. A search through the databases found no randomised trials comparing various techniques, except one study which compared an umbilical clamp with the routine fixing method.
Accidental extubation or unsatisfactory positioning of the tube may influence the reintubation rate. Securing and properly stabilising an endotracheal tube can solve this problem to a large extent.
A prospective randomised trial evaluating each method against reintubation criteria will help neonatal units to adopt the correct policy for their own situation.
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