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Unplanned Extubation Services
In health care, a significant threat to ventilated patient safety is Unplanned Extubation, which occurs when a patient or other external force pulls an inadequately stabilized breathing tube out of the airway (7,11,41,42).
Every year, unplanned extubation impacts more than 121,000 patients, causes over 36,000 cases of ventilator-associated pneumonia, leads to more than 33,000 preventable deaths, and adds more than $4.9 billion in wasteful healthcare costs. The median incidence rate of Unplanned Extubation is 7.3% in all ventilated ICU patients (7,11,41,42). As the current standard of care, this is unacceptable.
It Starts with Securement
Unplanned extubation can only occur when an endotracheal tube is inadequately secured, allowing forces, either applied by the patient (self-extubation) or externally applied by other than the patient (accidental extubation), to dislodge the tube out of the trachea (20,21). Current securement practices fall into two broad categories.
Tape, Adhesive, or Twill Securement
The first category of securement practices utilizes tape. Cotton twill tape is “tied” around the endotracheal tube and then anchored around the patient’s neck. Adhesive tape is adhered to the patient’s cheeks or wrapped around the patient’s neck.
Commercial Device Securement
The second category of securement practices utilizes commercial devices specifically designed to secure endotracheal tubes via any one of a number of mechanical methods that grip, squeeze, or adhere to the tube while also facilitating ease of application and improved oral care while minimizing pressure-induced skin and oral mucosa injuries. Device effectiveness is typically measured by its ability to hold the endotracheal tube in place against the greatest amount of force, ease of application, and the ability to minimize pressure damage the device causes to oral mucosa, lips, and facial skin (20,22).
Unplanned Extubation increases with the following factors:
- Patient restlessness/agitation (7)
- Inadequate sedation (10,37)
- Use of physical restraints (37)
- Absence of clear policies and procedures related to weaning (10)
- Factors related to nursing staffing such as night shift, inexperienced ICU nurses, or unit characteristics that prevent adequate nursing observation (7)