ET tube concern

Nalon1 RN/EMT-P, BSN, RN · Oct 7, 2015

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 · Oct 7, 2015

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 · Oct 12, 2015

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 · Oct 12, 2015

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 · Oct 12, 2015

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