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Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery: A prospective, randomized controlled study.

Byun SH, Kang SH, Kim JH, Ryu T, Kim BJ, Jung JY - Medicine (Baltimore) (2016)

Bottom Line: After lateral positioning, there were no significant differences in changes in tracheal and bronchial depths between the groups (tracheal depth 6.1 ± 4.4 mm [R group] and 9.1 ± 5.6 mm [T group], P = 0.058; bronchial depth 6.5 ± 4.4 mm [R group], and 8.5 ± 4.6 mm [T group], P = 0.132).Although the amount of change in tracheal and bronchial depths was not different between the groups, the need to reposition the DLT was significantly lower in the R group than in the T group (32% vs 68%, P = 0.016).This study demonstrated that use of Rescuefix did not reduce the amount of DLT displacement, but it did significantly lower the incidence of DLT repositioning compared with the tape-tying method.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea.

ABSTRACT

Background: Double-lumen endotracheal tubes (DLTs) are often displaced during change from the supine to the lateral decubitus position. The aim of this study was to determine whether Rescuefix, a recently developed tube-holder device, is more effective than the traditional tape-tying method for tube security during lateral positioning.

Methods: Patients were randomly assigned to a Rescuefix (R) group (n = 22) or a tape (T) group (n = 22). After intubation with a left-sided DLT and adjustment of the appropriate DLT position using a fiberoptic bronchoscope, the DLT was fixed firmly at the side of the mouth by either Rescuefix or Durapore tape. "Tracheal depth" (from the tracheal carina to the elbow connector of the DLT) and "bronchial depth" (from the left bronchial carina to the elbow connector of the DLT) were measured in the supine position using the fiberoptic bronchoscope. After positional change, tracheal and bronchial depths were measured as described above. As the primary endpoint, displacement of the DLT during positional change was evaluated by obtaining the difference in depths measured when the patient was in the supine and lateral decubitus positions. In addition, after lateral positioning of the patient, any requirement for repositioning the DLT was recorded.

Results: After lateral positioning, there were no significant differences in changes in tracheal and bronchial depths between the groups (tracheal depth 6.1 ± 4.4 mm [R group] and 9.1 ± 5.6 mm [T group], P = 0.058; bronchial depth 6.5 ± 4.4 mm [R group], and 8.5 ± 4.6 mm [T group], P = 0.132). Although the amount of change in tracheal and bronchial depths was not different between the groups, the need to reposition the DLT was significantly lower in the R group than in the T group (32% vs 68%, P = 0.016).

Conclusion: This study demonstrated that use of Rescuefix did not reduce the amount of DLT displacement, but it did significantly lower the incidence of DLT repositioning compared with the tape-tying method. Therefore, Rescuefix appears to be an effective alternative to minimizing DLT displacement during lateral positioning in thoracic surgery.

Trial registration: http://cris.nih.go.kr identifier: KCT0001949.

No MeSH data available.


Related in: MedlinePlus

(A) Photograph of the Rescuefix tube-holder device. The plastic tube clamp grips the endotracheal tube. The flexible flange with a foam cushion can adapt to the patient's face. The length-adjustable neck tape wraps the patient's neck with a Velcro strap. (B) Photograph of the Rescuefix device applied to a patient in the lateral decubitus position.
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Figure 1: (A) Photograph of the Rescuefix tube-holder device. The plastic tube clamp grips the endotracheal tube. The flexible flange with a foam cushion can adapt to the patient's face. The length-adjustable neck tape wraps the patient's neck with a Velcro strap. (B) Photograph of the Rescuefix device applied to a patient in the lateral decubitus position.

Mentions: Therefore, securing the ETT safely becomes as important as tracheal intubation itself to prevent displacement of the ETT, and several methods, such as adhesive tape or a tube-holder, have been developed to fix the ETT securely on the patient. Recently, a manikin-based study showed that a tube-holder device provided significantly more tube security than a conventional tape-tying method during simulation of continuous chest compressions.[4] A subsequent clinical study demonstrated that the tube-holder was more effective than adhesive tape in preventing displacement of an ETT in patients undergoing surgery in the prone position.[5] In these studies, the tube-holder device used was the Thomas Endotracheal Tube Holder (Lærdal, Norway), which has a hard plastic face plate and a quick-set screw clamp for fixing the ETT. A more recent development has been the Rescuefix (VBM Medizintechnik, Sulz, Germany), a novel tube-holder consisting of a flexible flange that adapts to the unique shape of an individual patient's face. The Rescuefix also includes a tube clamp that guarantees rapid and safe fixation of the ETT without the use of screw-type devices, so should be able to be applied more easily (Fig. 1). Hence, Rescuefix might be a useful alternative for securing the DLT, even during lateral positioning when displacement of the DLT often occurs. The aim of this study was to determine whether Rescuefix could be more effective than the traditional method of tube fixation using adhesive Durapore tape (3M, St Paul, MN) during lateral positioning in thoracic surgery.


Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery: A prospective, randomized controlled study.

Byun SH, Kang SH, Kim JH, Ryu T, Kim BJ, Jung JY - Medicine (Baltimore) (2016)

(A) Photograph of the Rescuefix tube-holder device. The plastic tube clamp grips the endotracheal tube. The flexible flange with a foam cushion can adapt to the patient's face. The length-adjustable neck tape wraps the patient's neck with a Velcro strap. (B) Photograph of the Rescuefix device applied to a patient in the lateral decubitus position.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979847&req=5

Figure 1: (A) Photograph of the Rescuefix tube-holder device. The plastic tube clamp grips the endotracheal tube. The flexible flange with a foam cushion can adapt to the patient's face. The length-adjustable neck tape wraps the patient's neck with a Velcro strap. (B) Photograph of the Rescuefix device applied to a patient in the lateral decubitus position.
Mentions: Therefore, securing the ETT safely becomes as important as tracheal intubation itself to prevent displacement of the ETT, and several methods, such as adhesive tape or a tube-holder, have been developed to fix the ETT securely on the patient. Recently, a manikin-based study showed that a tube-holder device provided significantly more tube security than a conventional tape-tying method during simulation of continuous chest compressions.[4] A subsequent clinical study demonstrated that the tube-holder was more effective than adhesive tape in preventing displacement of an ETT in patients undergoing surgery in the prone position.[5] In these studies, the tube-holder device used was the Thomas Endotracheal Tube Holder (Lærdal, Norway), which has a hard plastic face plate and a quick-set screw clamp for fixing the ETT. A more recent development has been the Rescuefix (VBM Medizintechnik, Sulz, Germany), a novel tube-holder consisting of a flexible flange that adapts to the unique shape of an individual patient's face. The Rescuefix also includes a tube clamp that guarantees rapid and safe fixation of the ETT without the use of screw-type devices, so should be able to be applied more easily (Fig. 1). Hence, Rescuefix might be a useful alternative for securing the DLT, even during lateral positioning when displacement of the DLT often occurs. The aim of this study was to determine whether Rescuefix could be more effective than the traditional method of tube fixation using adhesive Durapore tape (3M, St Paul, MN) during lateral positioning in thoracic surgery.

Bottom Line: After lateral positioning, there were no significant differences in changes in tracheal and bronchial depths between the groups (tracheal depth 6.1 ± 4.4 mm [R group] and 9.1 ± 5.6 mm [T group], P = 0.058; bronchial depth 6.5 ± 4.4 mm [R group], and 8.5 ± 4.6 mm [T group], P = 0.132).Although the amount of change in tracheal and bronchial depths was not different between the groups, the need to reposition the DLT was significantly lower in the R group than in the T group (32% vs 68%, P = 0.016).This study demonstrated that use of Rescuefix did not reduce the amount of DLT displacement, but it did significantly lower the incidence of DLT repositioning compared with the tape-tying method.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea.

ABSTRACT

Background: Double-lumen endotracheal tubes (DLTs) are often displaced during change from the supine to the lateral decubitus position. The aim of this study was to determine whether Rescuefix, a recently developed tube-holder device, is more effective than the traditional tape-tying method for tube security during lateral positioning.

Methods: Patients were randomly assigned to a Rescuefix (R) group (n = 22) or a tape (T) group (n = 22). After intubation with a left-sided DLT and adjustment of the appropriate DLT position using a fiberoptic bronchoscope, the DLT was fixed firmly at the side of the mouth by either Rescuefix or Durapore tape. "Tracheal depth" (from the tracheal carina to the elbow connector of the DLT) and "bronchial depth" (from the left bronchial carina to the elbow connector of the DLT) were measured in the supine position using the fiberoptic bronchoscope. After positional change, tracheal and bronchial depths were measured as described above. As the primary endpoint, displacement of the DLT during positional change was evaluated by obtaining the difference in depths measured when the patient was in the supine and lateral decubitus positions. In addition, after lateral positioning of the patient, any requirement for repositioning the DLT was recorded.

Results: After lateral positioning, there were no significant differences in changes in tracheal and bronchial depths between the groups (tracheal depth 6.1 ± 4.4 mm [R group] and 9.1 ± 5.6 mm [T group], P = 0.058; bronchial depth 6.5 ± 4.4 mm [R group], and 8.5 ± 4.6 mm [T group], P = 0.132). Although the amount of change in tracheal and bronchial depths was not different between the groups, the need to reposition the DLT was significantly lower in the R group than in the T group (32% vs 68%, P = 0.016).

Conclusion: This study demonstrated that use of Rescuefix did not reduce the amount of DLT displacement, but it did significantly lower the incidence of DLT repositioning compared with the tape-tying method. Therefore, Rescuefix appears to be an effective alternative to minimizing DLT displacement during lateral positioning in thoracic surgery.

Trial registration: http://cris.nih.go.kr identifier: KCT0001949.

No MeSH data available.


Related in: MedlinePlus