Securing infant tracheal tubes

Small head movements can cause significant tracheal tube migration in infants unless the tube is adequately secured.

Many use a version of the Melbourne strapping method:

1. Equipment required: Silk suture (cut off needle), ‘Cavilon’, elastoplast cut into 3 strips – 2 trouser shaped, and one with a 4cm hole in middle.

2. Apply Cavilon to face (a barrier film to protect the skin) over the area shown by red blobs in the picture.

3. Tie the suture around the tracheal tube. This marks the tube position at the mouth, and allows the tube to be held in place during fixation and when the tapes are later changed.

Pull the two ends taut across both cheeks.

3. While the suture is being pulled taut, place the first ‘trousers’ so that the undivided end is along the cheek (over the tape). The lower ‘leg’ is placed between the lower lip and the chin.

The upper ‘leg’ is folded back on itself to make it easier to removed at a later stage. It is then wound around the tracheal tube

4. The second set of ‘trousers’ is then applied on the other side, once again with the undivided end over the cheek and suture.

The upper ‘leg’ goes between the nose and the top lip and the lower leg is wound around the tracheal tube.

5. Finally the third piece of elastoplast is placed so that the tube goes through the hole

and applied over the other tapes. If there is an orogastric tube this should also go through the hole. The tube is now secure for transfer.