[Guinness02]

Nothing beats a CXR to tell you how deep you are in the esophagus.

[NoviceToExpert]

Keep on top of the basic assessments and back it up with the tests...no one has mentioned abdominal distention or your basic SpO2 monitoring while waiting for the CXR...all good points on the thread, no doubt... but as someone already mentioned you need more than one piece of data for confidence... so I wouldn't rely on just one... I don't think anyone here on this site would...

[NoviceToExpert]

Originally Posted by Guinness02

Nothing beats a CXR to tell you how deep you are in the esophagus.

That's very funny!!!

[SWEnfermera]

Remember,
A CXR is only a 2-D image. It only tells you where the ET tube is in relationship to the level of the carina, it does not tell you if you are in the trachea or esophagus. You shouldn't rely on only one assessment tool. You should check all; sats, auscultation, ETCO2, and CXR. If even one is questionable, then question your placement.
I do agree, broncoscopy is definitely the best way to determine placement but not always available in smaller hospitals, whereas the other tools usually are.

[anurseuk]

Straight after intubation?

We would immediatly to auscultation for equal air entry etc and then confirm with CXR. Then we'd record length at which the ETT is tied and then we know if it's slipped etc later on.

You would also do an ABG and you can tell by the pt's oxygenation by comparing it to a pre intubation gas.

Hope that helps.

[joeyzstj]

Originally Posted by SWEnfermera

Remember,
A CXR is only a 2-D image. It only tells you where the ET tube is in relationship to the level of the carina, it does not tell you if you are in the trachea or esophagus. You shouldn't rely on only one assessment tool. You should check all; sats, auscultation, ETCO2, and CXR. If even one is questionable, then question your placement.
I do agree, broncoscopy is definitely the best way to determine placement but not always available in smaller hospitals, whereas the other tools usually are.

I agree with the above, and inspection with an intubation scope isnt that wild of an idea. We have a self contained brochoscope just for this reason. Another idea would be to use a glide scope where you can easily visualize the scope passing. As SWE mentioned above, a CXR is the gold standard, however it does NOT tell you the placement in relationt to depth. You coul have proper placement as far as depth is concerned, however it could still be in the esophagus. This is where listening to breath sounds, easy capnography and check for consensation in the tube come into play. A tube should NEVER be placed unless it is directly visualized by the practitioner to pass through the vocal cords. I have intubated many people and never had an esophageal intubation due to this. In my opinion, if I had to pick ONE single way, it would be to visulaize it with a bronchoscope. In some hospitals this is quite common.