The Damage We Cause: Airway Securing Devices and Pressure-Induced Injuries

Abstract

Background: Securing an artificial airway in an intubated patient is of the utmost importance to avoid accidental extubations. Endotracheal tube (ETT) securing devices are associated with medical device-induced pressure ulcers (MDIPUs) and rates range between 7%-45%. MDIPUs have severe consequences for patients, clinicians, and facilities. This educational pre and post design study examined the knowledge of MDIPUs in a senior respiratory therapy program.

Methods: A 10-item pre-test based on a thorough literature review targeting pathophysiology, prevention, and treatment of MDIPUs related to ETT retaining devices was administered immediately before an in-person lecture and hands on exercise to entry level respiratory students. The same test was administered immediately after the education program to compare information retention and understanding.

Results: The class average on the pre-test was 51.9% ± 9.2% (mean ± 95% CI). Out of 14 students (7.1%) met or exceeded the criterion of success (70%) for the pre-test. The difference between the pre-test score and the criterion of success was statistically significant: t(13) = -3.85, P < .005. The difference between these scores had a large effect size (Cohen's d = -1.03). The class scores on this test fell short of meeting the criterion of success for this assessment. The class average on the post-test was 81.9% ± 10.9% (mean ± 95% CI). A total of 11 out of 14 students (78.6%) met or exceeded the criterion of success for the post-test. The difference between the post-test score and the criterion of success was not statistically significant: t(13) = 2.14, P > .05. The difference between these scores had a medium effect size (Cohen's d = 0.57). The difference between the pre-test and post-test scores (30%) was statistically significant using a two-tailed paired t-test: t(13), P < .001. The magnitude of this difference has a very large effect size (Cohen's d = 1.62).

Conclusions: Entry level students' knowledge about avoiding MDIPU caused by airway securing devices increased after a lecture and hands-on exercise. Future research needs to be done across more respiratory care programs.