ET tube concern

Specialties MICU

Published

How many cm of ET tube movement (from initial baseline) would it take until you get really concerned about possible displacement? (aside from assessing lung sounds).

Thanks for any input.

Textbook answer, no movement at all from confirmation with x-ray, but real world, it depends on several factors, how deep/shallow was the initial placement and patient size being the biggest ones.

Up to 2 cm could be fine for many (but I would be highly suspicious), but others could be less than 1/2 cm.

It truthfully comes down to assessment and patient condition to determine it.

FlyingScot, RN

2,016 Posts

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Patient size comes into play as well. Although I am petite I have a very long neck ( I need a "tall" c-collar) so 2cm on me wouldn't make much difference. But take a guy who has no neck that 2 cm could be the difference between proper placement and disaster.

PaSSiNGaS, MSN

261 Posts

Specializes in Nurse Anesthesiology.

Rule of thumb is 20-22cm at the lip for women and 22-24cm at the lip for men. If the tube was pulled out to 18-19 on either I would definitely worry it could be sitting right at the glottic opening. Deeper than 24cm for a woman I would worry it could be in the right main stem or sitting right on the carina.

nurs1ng

149 Posts

Rule of thumb is 20-22cm at the lip for women and 22-24cm at the lip for men. If the tube was pulled out to 18-19 on either I would definitely worry it could be sitting right at the glottic opening. Deeper than 24cm for a woman I would worry it could be in the right main stem or sitting right on the carina.

In regards to this, I had a pt who had a CXR done as I got on the floor and saw on the film that the tube was directing more towards the right main stem. Notified the MD and ordered to push in the tube 1-2 cm more. Not sure what the rationale for this was, but I thought that the MD would order to pull out instead of pushing further in. My only rationale was that by pushing it 1-2 cm further in, that it would somehow redirect itself to the bifurcation?

PaSSiNGaS, MSN

261 Posts

Specializes in Nurse Anesthesiology.

Not sure there. You want the tube about 3-5cm above the carina

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