Brief Summary
This video captures a teaching session focused on securing an artificial airway, specifically an endotracheal tube (ET). The session involves a practice round where Mary Chris, the learner, gets hands-on experience under supervision, followed by a "teach one" session where she demonstrates the skill. Key areas of focus include safety considerations, proper technique for securing the ET tube with tape and ties, and the importance of using a checklist and seeking guidance from senior staff. The session concludes with feedback and a discussion on future goals for improving competence and confidence in this critical skill.
- Safety considerations are paramount, including knowing the ET tube's placement and cuff pressure.
- Proper technique involves using both tape and ties for securement, with specific steps to follow.
- Checklists and senior guidance are crucial for novice practitioners to ensure patient safety and build confidence.
Practice Round and Safety Considerations
Mary Chris and the instructor begin with a practice round to secure an ET tube on an airway management trainer. The instructor emphasizes the importance of understanding the purpose of each item, such as ties, spare ties, tape, and scissors. They discuss safety considerations, including verifying the ET tube's position to ensure proper lung ventilation and checking cuff pressure to prevent air leaks. Mary Chris recalls the need to know the level where ET sits to avoid ventilating the stomach or only one bronchus.
Securing the ET Tube with Tape
The instructor guides Mary Chris through the steps of securing the ET tube, starting with the pre-prepared tape that has a slit. The purpose of the slit is to anchor the tape to both the face and the tube. Mary Chris then tapes the ET tube to the patient, ensuring it is close to the lip while still allowing the markings on the tube to be visible. The instructor acts as a second person to stabilize the tube during the taping process. They confirm the ET tube is sitting at 11 cm at the lip.
Using Ties for Additional Securement
The session moves on to using ties for additional securement, a standard practice at their training hospital. Mary Chris attempts the looping technique, and the instructor provides reminders and feedback. They emphasize the importance of taking time to ensure the ties are secure, as accidental dislodgement of the artificial airway is a medical emergency. The instructor advises securing the ties above one ear and below the other for maximum stability.
Feedback and Future Goals
After the practice and "teach one" sessions, the instructor and Mary Chris discuss her performance. Mary Chris acknowledges the need for guidance and reminders about safety protocols and recognizes the value of using a checklist and having a senior colleague present. The instructor notes that Mary Chris met most of the checklist criteria but needs more confidence and familiarity with the equipment and steps. Mary Chris commits to reviewing the policy, using the checklist, and seeking supervision from a senior person until she feels competent. She also acknowledges that efficiency and confidence will improve with experience, and the instructor praises her for prioritizing patient safety by taking her time.
