A Modified Tie Technique for Securing Endotracheal Tubes

Unintentional extubation is a well-documented and potentially life-threatening phenomenon. There is little research into the factors that lead to unintentional extubation, and therefore how to prevent it. Endotracheal tubes (ETTs) are commonly secured with 1 cm twill tape, but there is little evidence on how to best tie them in place. We have devised a new knot for securing these tubes in place, and we have assessed its degree of slippage when exposed to both perpendicular and sliding forces in comparison with other commonly used knots.

We constructed a weighted apparatus to test the effects of these forces and measure whether conventional ETTs slipped. We tested the knots both wet and dry to better simulate the clinical environment. We also conducted a manual manipulation test in which a single operator attempted to slide the knot along the ETT. Each knot was tested 10 times for the weight test under both wet and dry conditions, and 8 times for the slip test.

The normal knot slipped when weighted both wet and dry, while the clove hitch failed the weight test only when wet. Both the modified cow hitch and double hitch withstood all weights. Only the double hitch did not slip under any circumstances on either test.

The new double hitch was superior to all conventional knots tested. It did not slip under any conditions and therefore may be of use to prevent unintentional extubation, particularly in the ICU setting.