Endotracheal Tube Position

The endotracheal tube position should always be confirmed because the correct placement of the tube is essential for proper ventilation of a person. If the endotracheal tube position is not correct within no time the patient can become hypoxic due to the unavailability of oxygen to the lungs.

The tube may be wrongly placed in the esophagus, which is one of the commonest complication of orotracheal intubation. Another possibility is that the tube might have been pushed deeper resulting in an endobronchial intubation. Thus, it is mandatory to confirm the endotracheal tube position immediately after orotracheal intubation.

Checking for the correct position of tube after an endotracheal intubation is a very important part in the proper ventilation of a patient. If the tube is placed improperly, the adequate supply of oxygen to the lungs may not be maintained and the patient may develop hypoxia and die.

The Endotracheal tube or the ET tube may be wrongly placed in the esophagus, which can result in Aspiration of the gastric content into the lungs.

The Endotracheal tube may some times be pushed far in the trachea so that it enters one of the Main bronchus, most commonly the right bronchus, resulting in selective ventilation of the right lung only and the collapse of the left lung. This improper position of tube is easily avoidable.

When the position of tube is not proper the patient can develop hypoxia and die.

The following methods are used to check the endotracheal tube position.

Checking for Correct endotracheal tube position of Tube

1. Auscultation of chest for air entry: This is the most common technique to confirm the proper placement of the tube. The chest needs to be auscultated every time the position of the patient is changed as this can result in accidental extubation or accidental endobronchial placement of the tube. The auscultation is done in seven areas, that is both the apices, both the bases of the lung, both axillas and the epigastric region.

2. Characteristic feel of bag.

3. Chest inflation on positive pressure.

4. Capnograpy (measuring end tidal C02): It is the Surest sign of the correct Endotracheal Tube Position..

5. Fibreoptjc bronchoscopy; It is also confirmatory but practically not available routinely therefore capnography is considered best for confirmation.

6. Esophageal detector devices: It is a self inflating bulb which is applied to the end of tube. If the tube is in trachea it inflates due to expired tidal volume but when the tube is in esophagus it remains deflated. It has so many false positive and negative therefore not used routinely.

Updated 1/2/2018

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