Читать книгу Emergency Medical Services - Группа авторов - Страница 102

EMS personnel must adequately secure the endotracheal tube or supraglottic airway to prevent device dislodgement. The most common method for securing the endotracheal tube is the use of adhesive tape wrapped around the neck and the endotracheal tube (Lillehei method) [72]. Another method uses umbilical twill tape, which is a flat, woven cloth tape designed for tying off umbilical cords after childbirth. Some EMS personnel use intravenous or oxygen tubing to tie the endotracheal tube in place. A variety of commercial tube holders also exist, typically consisting of a plastic bite block strapped to the patient’s face using Velcro tape and a plastic strap or screw clamp to hold the endotracheal tube in place. Current ACLS guidelines recommend the use of commercial tube holders. However, one cadaver study found that conventional adhesive taping of the endotracheal tube surpassed most commercial tube holders [72]. The one exception was the Thomas Tube Holder™ (Laerdal Medical, Inc., Stavanger, Norway), which performed better than taping. Only limited prehospital clinical data describe the effectiveness of endotracheal tube securing methods at preventing tube dislodgement [73]. There are also no data describing the effectiveness of spinal or cervical immobilization devices at preventing tube dislodgment.

Some EMS personnel manually hold the endotracheal tube in place without using tape or other tube security methods. We do not recommend this method, as anecdotal reports have associated this technique with inadvertent tube dislodgement. In addition, the force required to dislodge many devices is increased substantially by securing them in place [74]. Because of the theoretical risk of tube dislodgement with flexion‐extension or lateral rotation of the head, some EMS clinicians also apply a cervical collar.

EMS personnel should also secure supraglottic airway devices such as the i‐gel, LT airway, and LMA. The manufacturers recommend conventional taping methods for securing these airways (LT airway and LMA) or the use of a proprietary holder (i‐gel). We have observed that some commercial tube holders are not designed for supraglottic airways (which have wider outer diameters than endotracheal tubes) and do not adequately hold these devices in place.