Pediatric Endotracheal Tube Securement: A Bench Comparison of Traditional Fixation Methods

Introduction: Neonates, infants, and children have unique challenges with endotracheal tube securement placing them at high risk for unplanned extubation. Existing securement techniques are limited to tape, NeoBar®, and AnchorFast™. We sought to determine the force required to displace the endotracheal tube under two simulated clinical scenarios.


Methods: Endotracheal tubes were fastened to custom-built infant and pediatric mannequin heads using 3 traditional securement methods and then subjected to conditions of continuous force application using the Mark-10® force gauge (slow continuous pull) as well as static tug movement using a mechanical low-friction pulley apparatus (rapid jerk). Heads were placed in 4 different positions (neutral, lateral, 45° upward, 45° downward) and 3 repetitions were performed in each direction. In all trials, failure was defined as displacement of the endotracheal tube by 2 cm or the device breaking. Kaplan-Meier curves were used to assess and compare the percentage of failure as a function of force with each device.


Results: For force gauge testing, 50% of NeoBar® devices failed by 7 lbF, and 100% by 8lbF. For tape, 50% failed by 6 lbF, 75% by 8 lbF, and 100% by 10lbF. For AnchorFast™ 50% failed by 18 lbF, 75% by 20 lbF and 100% by 25 lbF (p < 0.001). For static tug testing, 50% of NeoBar® devices failed by 600g, 75% by 700g and 100% by 900g. Tape had 50% fail by 600g, 75% by 700g with approximately 10% remaining in tact at 1000g. The AnchorFast™ had many devices snap, resulting in 50% failure by 400g, 75% at 500g and 100% by 700g (p < 0.001).


Conclusions: AnchorFast™ appears to tolerate higher continuous force as compared to tape and NeoBar® but may be subject to device failure with short, quick tugging motions.