by Kwest70

Hello everyone-

Several of us new nurses are debating which method is best to determine ET Tube Placement...

Ausultating breath sounds vs. end-tidal CO2 measurement

My position is that auscultating bilateral breath sounds leaves room for error. In other words, it's only as reliable as the skills of the person performing it.

Any thoughts?

Thank you!!

Re: How To Determine ET Tube Placement

I recommend doing both, having said that. co2 is the most accurate method of the two.

Re: How To Determine ET Tube Placement

End tidal is the most accurate determination of placement. Certainly nothing beats a chest x-ray!

Re: How To Determine ET Tube Placement

End Tidal will show if it is down the esophagus or trachea. Bilateral breath sounds will help determine if it went down one bronchus. A chest x-ray will truly show where it is placed. Prior to a CXR do an end tidal.

Re: How To Determine ET Tube Placement

end-tidal capnography is the gold standard. bilateral breath sounds will help to tell if it is in one mainstem bronchus or the other, the chest film will only confirm the tube's position relative to the carina, e.g. if it's in the esophagus the CXR probably won't look much different (of course you've verified placement prior to the film)
The problem I've found with bilateral breath sounds is that if a patient has aspirated or has any significant fluid build-up, it's difficult to differentiate breath sounds from epigastric. Having positive and sustained EtCO2 levels on the monitor is confirmation for me.
Also don't forget visualizing the tube actually passing through the cords and having condensation inside the tube.

Re: How To Determine ET Tube Placement

Originally Posted by BypassThisNurse

End tidal is the most accurate determination of placement. Certainly nothing beats a chest x-ray!

DITTO!!! Chest X-Ray is the Gold standard for ETT placement verification.

Re: How To Determine ET Tube Placement

In my opinion all of the modalities that were mentioned can leave room for error. To me, auscultating breath sounds, using end-tidal CO2 detector and a follow-up CXR post intubation are all necessary to confirm placement of an ET tube. No steps should be omitted. If placement is confirmed via all these routes, then I would be confident that the ET tube is OK. The only single way to confirm "correct" placement of an ETT without leaving any question of misplacement is direct visualization of the ET tube with a bronchoscope and checking for where the tip of the ET ends as it relates to the location of the patient's carina.

Re: How To Determine ET Tube Placement

hi every one i'm a new member:

there are several methods to confirme ETT placement:
etco2, detector, auscultation, chest x ray as well as EDD.
the most accurate and fastest method is the ETCO2 DECTOR but it might not be available at every instituatios, the ausculatation method is the most common used in emergency situation and as follow up procedure chest x ray to confire the placment and the location. this is in short

Re: How To Determine ET Tube Placement

Originally Posted by pinoyNP

In my opinion all of the modalities that were mentioned can leave room for error. To me, auscultating breath sounds, using end-tidal CO2 detector and a follow-up CXR post intubation are all necessary to confirm placement of an ET tube. No steps should be omitted. If placement is confirmed via all these routes, then I would be confident that the ET tube is OK. The only single way to confirm "correct" placement of an ETT without leaving any question of misplacement is direct visualization of the ET tube with a bronchoscope and checking for where the tip of the ET ends as it relates to the location of the patient's carina.

So a Sa02, Abgs, ETCO2, EBBS and a PCXR (ALL done in a pt <5 mins p a non surgical intubation) would make you "confident" the ETT is "OK"? You want everyone to have a bronch?

Why not just go for a CT to check ETT placement? Thats just as pragmatic as your bronch comment.

Re: How To Determine ET Tube Placement

Originally Posted by TopherSRN

So a Sa02, Abgs, ETCO2, EBBS and a PCXR (ALL done in a pt <5 mins p a non surgical intubation) would make you "confident" the ETT is "OK"? You want everyone to have a bronch?

Why not just go for a CT to check ETT placement? Thats just as pragmatic as your bronch comment.

At what point did I say in my post that I want "everyone" to have a bronch? I happen to be a nurse practitioner in an ICU setting and NOT in an OR setting. And in case you forgot, this is an ICU-focused thread. In my practice, everytime anesthesia intubates, they put in the tube after end-tidal CO2 and breath sounds confirmation. But more often than not, I would have to ask respiratory to readjust the tube because the follow-up x-ray shows that the tube placement is either too high or too low.

There have been problems in the past where I work when anesthesia intubated and the ET tube is incorrectly placed. I am not going to sacrifice my license by allowing these mistakes to happen. These are my patients and not anesthesia's!

Good try on the CT. That would mean the patient would have to leave the unit. No thanks with that. With the bronch, I can just bring the cart to the room and visualize it myself...I would rather do that, thank you very much.