Gripping Technique for Endotracheal Tube- Beedi vs Cigarette Grip, which is better?

Abstract

Objective: To compare the efficacy of two manual grips for holding Endotracheal (ET) tube during confirmation, fixation and patient movement. Methods: We conducted a prospective observational study of adult patients undergoing endotracheal intubation and intubated patients undergoing shifting in the Emergency Department (ED) of a tertiary level hospital. This was done over a period of 14 months from August 2020 to September 2021. The method of holding the ET tube manually using Cigarette grip (holding with index and middle finger) vs Beedi grip (holding with thumb and index finger) prior to fixation and during patient movement was the variable taken into account and displacement of the ET tube if any was noted as outcome. Results: During the study period, a total of 134 intubations were done and among them 196 instances had intrahospital transfer from ED. Beedi grip method was used in 74 (55.2%) patients compared to cigarette grip for 60 (44.8%) patients during fixation of ET tube. The most common reason for intrahospital shifting was for radiological imaging 114 patients followed by intensive care shifting of 82 patients. None of the patients had complete dislodgement of ET tube but displacement was seen in 6 (10%) patients cigarette grip vs 2 (2.7%) patients beedi grip during fixation. During shifting 18 (20.5%) patients with cigarette grip had displacement of ET tube vs 4 (3.7%) patients with beedi grip. Conclusion: In spite of ET intubations being a very common procedure, user variations exist regarding proper holding of the ET tube manually. The Beedi grip used for fine holding provides a more stable method of holding the ET tube as compared to the cigarette method.