Intubated patients

Specialties MICU

Published

I was just wondering is there any assessment that I as a new nurse can do to determine proper placement of and ET prior to the patient going for chest xray? Would the patients O2 sats show an increase if there was correct placement?

Thanks;)

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Specializes in Advanced Practice, surgery.

If it is a new placement or you think it has moved then the most important thing to do is look at your patient.

Equal chest movement, auscltate, respiratory rate and O2 sats, are there signs of resp distress.

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Assess breath sounds---> Are they equal bilaterally? Which side do you hear and which do you don't (is this normal?)?

CO2 Detector

Symmetrical Chest rise

Are they coughing and gagging?--->The tube could be on the carina

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Specializes in ICU, Flight, ER, Admin.

End tidal CO2 will confirm gas exchange. It is the most accurate method behind chest xray and actual visualization of the the ETT passing through the vocal cords into the trachea.

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Specializes in Cardiac.
End tidal CO2 will confirm gas exchange. It is the most accurate method behind chest xray and actual visualization of the the ETT passing through the vocal cords into the trachea.

End tidal will not verify proper placement of the ETT-it can still be on the Right bronchus and have proper color change. Of course it verifies it's not in the stomach, but my point is that new nurses can't just rely on end tidal CO2 and assume it's properly placed.

To the OP-The best assessment s/p intubation is auscultation.

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Specializes in ICU, Flight, ER, Admin.
End tidal will not verify proper placement of the ETT-it can still be on the Right bronchus and have proper color change. Of course it verifies it's not in the stomach, but my point is that new nurses can't just rely on end tidal CO2 and assume it's properly placed.

To the OP-The best assessment s/p intubation is auscultation.

That is incorrect. Auscultation of the lung fields is NOT the BEST assessment of placement ... ETCO2 is the best method (after direct visualization of tube passing through the vocals). Auscultation can fool you ... especially in ARDS, aspiration, and a lot of trauma situations. ETCO2 will tell you that you are having gas exchange (our goal) ... and that you are at least ventilating the lung fields! ETCO2 can also provide clues to right mainstem intubation. I am not saying not to auscultate ... you should always auscultate ... but ETCO2 is the most accurate method of ETT placement prior to xray. And we won't even get into neonatal and pediatric intubations .... I cannot tell you how many times as a flight nurse that I would have driven myself crazy questioning placement in these tiny guys if it wasn't for end tidal monitors!! Anyway, never seen end tidal fail ...cannot say the same for auscultation. :typing

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Of course it verifies it's not in the stomach, but my point is that new nurses can't just rely on end tidal CO2 and assume it's properly placed.

To the OP-The best assessment s/p intubation is auscultation.

ETCO2 will tell you that you are having gas exchange (our goal) ... and that you are at least ventilating the lung fields!

I agree with you BTN, better to be in one lung as opposed to ventilating the stomach :lol2:

we're not talking about checking placement with only one method. A respiratory assessment (auscultation, visual assessment of the chest, ETCo2 etc) is what you're after. You will be getting an urgent CXR post tubing, but while waiting, we just want to know that we are in the lungs somwehere, as opposed to oxygenating the stomach lol.

ETCo2 will show you that your tube is generally in the right spot (ie- trachea, not oesophagus). Auscultation will help show you if you're getting in the lungs (or only one, if that is the case). If the doc has put it down the right main bronchus it should show on your CXR, and can be repositioned accordingly.

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