Displaced ETT in prone position

Discussion was around how to secure a tube for a patient going prone and what to do if a tube “falls” out while in the prone position (with the notion that it was/would be virtually impossible to re-intubate whilst still prone).

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Crisis management of a displaced tube in prone position (one possible strategy):

  • Inform theatre team of need to flip patient supine ASAP
  • Anaesthetist
    • Activate Scout Nurse
    • 10L 100% oxygen
    • Insert LMA
    • Give muscle relaxant
    • Remember to keep patient anaesthetised
  • Scout Nurse
    • Get anaesthetic help
    • Call for orderlies
    • Bring patient bed in
  • Re-intubate patient in supine position
  • Secure ETT using different fixation method

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Securing ETT for prone position:

Range of techniques suggested. Choice will also depend on surgical access required.

Remember to leave an exit for saliva!

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Links:

SGH ICU Protocol

Accidental Tracheal Extubation

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