How to use a disposable tube holder

In anesthesia, emergency treatment or intensive care, "tracheal intubation" is the "lifeline" that sustains a patient's breathing. But if this lifeline slips, twists or is clenched by the patient, the consequences will be unimaginable. To ensure that the catheter remains stable and does not fall off, it relies on a disposable tube insertion fixator.

The common disposable tube holders on the market are sterilized and individually packaged. After opening, they usually contain the following components:

The main body of the fixator: It has a "U" -shaped or circular tube slot in the center, and a knob/slide rail lock on the side

Occlusal plate/dental pad: Placed in the mouth, it prevents the patient from flattening the tube while protecting the lips and teeth

Sponge or silicone pads: Enhance comfort and reduce the risk of pressure sores

Fixing strap: It can be fastened around the neck or head, and the length is adjustable

Optional accessories: suction hole, observation window, tongue depressor, nasogastric tube slot, etc

Before use, be sure to check the sterilization label and expiration date. If the packaging is damaged, it will be scrapped and must not be reused.

Airway assessment: Confirm that the depth and position of the tracheal intubation are correct

Oral assessment: Whether there are dentures, bleeding or ulcers; If the denture is loose, it needs to be removed first

Skin assessment: Integrity of the skin on the cheeks, behind the ears and neck, avoiding pressure injuries or allergies

Model selection: For adults, the inner diameter of the commonly used tube is 6.0-8.0mm. The fixator needs to match the tube diameter. Children can choose the small size specially designed for pediatrics

The following steps integrate the mainstream ICU and anesthesiology operation norms at home and abroad and are applicable to 99% of disposable catheter fixators:

Step 1: Hand hygiene & Opening the package

Wash hands → Wear sterile gloves → Open the sterilized packaging → Place the fixator in the sterile area of the treatment tray

Step 2 Pre-loosen the lock

Loosen the fixed knob or the lock of the slide rail counterclockwise by 2 turns to facilitate the insertion of the tube. Check that the biting plate has no cracks

Step 3 Insert the tube into position

The assistant holds the outer end of the intubation steadily, and the operator inserts the intubation into the "U" -shaped groove. The outer wall of the intubation tube is in close contact with the groove wall, and the depth is marked towards the operator, which is convenient for observing the displacement later

Step 4: Insert the biting plate

Slide the front dental pad along the upper edge of the intubation into the mouth and place it between the upper and lower teeth. Confirm that the patient's tongue tip has not been pressed and that the lips naturally wrap around the occlusal plate

Step 5 Tighten the knob

Fix the relative position of the intubation tube and the fixator with one hand, and tighten the knob clockwise with the other hand until the intubation tube cannot slide up and down. If it is too tight, it may cause deformation of the pipe cavity; if it is too loose, it may slip off. Optimal torque: It can be turned by fingers without the need for auxiliary tools

Step 6: Fasten the neck strap

Wrap the elastic fixing band around the patient's neck (or head), tighten the Velcro first, then loosen it and make fine adjustments. It is advisable to insert one finger to avoid compressing the jugular vein. For patients with emaciation or edema, a small piece of gauze can be placed behind the ear to prevent pressure sores

Step 7 Recheck

Auscultation of breathing sounds in both lungs confirmed that the intubation had not shifted

Observe the color of the lips, the position of the occlusal plate, and the tightness of the fixing band

Record the exposed length of the intubation (from the incisor/nostril to the edge of the retainer in centimeters)

Evaluate the patient's comfort level and provide analgesia/sedation if necessary

Q1: What should be done if the patient has severe choking cough and the fixator has shifted?
Immediately assess the depth of intubation. If the exposed length changes by more than 1 cm, first loosen the knob to readjust, then auscultation to confirm the position, and take a chest X-ray if necessary.

Q2: The adhesive tape gets wet from blood/secretions and its stickiness decreases?
The spare fixing strap can be replaced at any time. Or use self-adhesive elastic bandages for enhanced wrapping to ensure that a new fixator is replaced within 2 hours.

Q3:How to quickly determine if the intubation tube has been flattened?

Observe the sudden increase in peak airway pressure of the ventilator and abnormal end-expiratory CO₂ waveforms; Immediately check the position of the bite plate and replace it with a reinforced dental pad if necessary.