Q We reviewed the new AACN Procedure Manual for Critical Care for guidance on oral hygiene for the intubated patient and came across the instructions to first remove the securing device or tape then perform oral care. We believe this set up the potential for endotracheal tube (ETT) “tromboning” or unplanned extubation. Can you clarify this procedure for us?

A Kathleen Vollman, rn, msn, ccns, ccrn, replies:

Thank you for taking the time to write in this question. It provided an opportunity to clarify a mistake written in the current procedure. The ETT should remain secure during any form of oral care to reduce the risk of unplanned or accidental extubation. The securing device and tape change should occur separately as an independent activity done before or after oral hygiene. If the securing device blocks the ability to provide oral hygiene, the device should be changed...

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