A Preventable Source of Patient Harm

Device-related pressure injuries remain a persistent and costly challenge in critical care settings. Among the most underrecognized contributors are endotracheal tubes (ETTs) and their traditional fixation techniques.

Conventional ETT holders rely on adhesive tape or plastic fasteners that keep the tube in place by anchoring it directly against the patient’s face. This creates high-risk pressure points at the oral commissures, philtrum, and cheeks, all of which are areas vulnerable to skin breakdown. Within as little as 48 to 72 hours, these pressure points can progress to Stage 2 or more severe injuries, significantly complicating the patient’s clinical course and outcomes.

The scope and impact of these injuries extend far beyond skin integrity. Hospital-acquired pressure injuries are among the leading sources of malpractice claims, second only to wrongful death.

From a care delivery perspective, clinicians often describe these wounds as “high-touch, high-burden” injuries, requiring frequent dressing changes, extensive documentation, and multiple specialty consults.

Yet despite their prevalence, these injuries are not inevitable. The 2022 EPUAP/NPIAP/PPPIA International Guideline explicitly identifies device-related pressure injuries as preventable harm. The guideline emphasizes minimizing skin contact, avoiding adhesives when possible, and enabling regular repositioning and inspection of devices.

Why Traditional Approaches Fall Short

Most legacy airway securement solutions fundamentally conflict with these best practices. By design, they depend on:

• Direct facial contact
• Adhesive fixation
• Limited flexibility for repositioning

These constraints make it difficult for clinicians to relieve pressure, increasing the risk of injury even with diligent care. In other words, the problem is not just how devices are used, it’s how they are designed.

The HORSESHOE™ Airway Security Device: Designed to Be Different

The HORSESHOE™ airway security device was developed to address the problem of facial pressure injuries at its source. Rather than attempting to mitigate pressure after it occurs, the HORSESHOE eliminates the primary causes of these injuries. Its unique off-the-face design removes direct contact with vulnerable facial tissues, aligning with guideline recommendations to reduce skin-device interaction.

At the core of the design is a cantilevered track system that suspends the ETT clamp away from the lips. This allows clinicians to reposition the tube laterally or medially with a simple slide, without removing the device or increasing manipulation. By distributing forces and avoiding fixed pressure points, the HORSESHOE enables proactive pressure management rather than reactive wound care.

Equally important, the system eliminates the need for adhesives or tape, which reduces the risk of skin trauma. This also simplifies care processes and improves consistency across shifts.

Innovative Stability Without Compromise

The HORSESHOE’s integrated soft Molar Props™ use jaw biomechanics to stabilize the device securely. This innovative approach provides reliable fixation of the ET tube without relying on external ties or facial pressure.

The Molar Props also create a functional mouth opening, facilitating suctioning and consistent oral care, while protecting the teeth, tongue, and tube from bite-related injuries.

Additionally, the device includes an accessory bracket that organizes other lines, such as nasogastric tubes, pilot balloons, and suction tubing, keeping them off the skin and reducing additional sources of pressure and irritation.

With the HORESHOE, clinicians can now address the root causes of pressure injuries by:

• Eliminating facial contact
• Reducing pressure concentration
• Enabling easy repositioning
• Avoiding adhesive-related trauma

By aligning device design with evidence-based guidelines, the HORSESHOE™ airway security device serves as a proactive safeguard against preventable harm.

For more information or an evaluation of the HORSESHOE airway security device, contact your local MED Alliance Group sales representative, call 888-891-1200 or email us.

MED Alliance Group is a medical device distributor that has been dedicated to meeting the needs of our clinical customers and manufacturing partners since 1998. We specialize in the sales, marketing, importation, logistics and distribution of innovative, high-quality and cost-effective products found in anesthesia and respiratory, blood and transfusion therapy, EMS and emergency room, interventional radiology and cath lab, iv and vascular, as well as NICU and PICU.

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