Authors (including presenting author) :
Leung KH(1), Chan TO(1), Lam KKT(1), Lee YT(1), To HY(1)
Affiliation :
(1) Paediatric intensive care unit, Department of Paediatrics, Prince of Wales Hospital
Introduction :
In PWH PICU, endotracheal tube (ETT) was commonly secured by doctor-led stitches method using adhesive tape and stitches. This provided a low unplanned extubation rate, but the following risks were also observed, including frequent restrapping, risk of needle-stick injury, and difficulty in oral and skin care. In fact, nurse-led non-stitches methods were suggested to be beneficial to the reduction of above risk.
Objectives :
This project aimed to implement a nurse-led non-stitches ETT securement in PICU and determine the impact in reducing the identified risk
Methodology :
The non-stitches ETT securement method was separated into adhesive tape (Phase 1: Transpore Clear with H-technique, Phase 2: Zinc oxide with H-technique) for ETT< 5mm and securement device for ETT>5mm. The primary outcomes were frequent restrapping rate, oral assessment scale and pressure injury rate. The secondary outcome was nurses’ compliance, evaluated by knowledge level, quality of practice and confidence level.
In order to ensure the compliance and feasibility of implementation, an education programme was organized in February 2024. Modification was applied from March to May 2024 with a monthly review under the PDSA cycle. Final evaluation and retrospective review of intubated cases in the past year was conducted in June 2024 according to the aspect of clinical performance and staff’s compliance.
Result & Outcome :
In the clinical performance, oral assessment scale and pressure injury rate maintained a high quality of performance under nurse-led non-stitches ETT securement. The rate of frequent restrapping was statistically significantly reduced (OR 0.096, P=0.049).
In the nurses’ compliance, the targeted knowledge level and quality of practice were achieved. The confidence level in new role allocation, applying device, and aftercare were also satisfactory, but that in strapping material and strapping technique were below target.
An unplanned extubation case with frequent restrapping was noted in phase 1. This was resulting in a significant reduction in the confidence level toward Transpore tape in ETT securement (Phase 1 material). The securement method was modified again (Phase 2) by changing Transpore+H-technique to ZnO+H-technique according to local and oversea experience. Compared with the previous method and Phase 1 modification, the modified method (Phase 2) could eliminate the risk of needlestick injury and show an increased confidence level of using new strapping material and technique were increased with a reduced restrapping rate.
Nurse-led non-stitches method could provide an effective ETT securement by eliminating the risk of needle-stick injury and reducing restrapping rate. However, extensive study and education in nurse-led practice about adhesive tape and strapping technique are necessary.
