ET Tube confirmation should be completed every time we intubate. Classic teaching like auscultating for breath sounds, epigastric sounds, visible chest rise, and fogging in the tube are unreliable.
Direct visualization of the ET tube passing through the vocal cords into the trachea is the Gold Standard, especially with a video laryngoscope. Still, additional techniques should be used as objective findings to confirm the proper ET tube position.
Use continuous waveform capnography and, if not available, colorimetric CO2 devices (Yellow=Yes; Purple= Problem) to evaluate and confirm endotracheal tube position in patients with adequate tissue perfusion.
Note that the Esophageal detector device (EDD) is not as reliable as the various forms of capnography for verifying endotracheal tube placement.
For patients in cardiac arrest and those with markedly decreased perfusion, continuous and non-waveform capnography may be less accurate. If capnography is inconclusive, other confirmation methods, such as an EDD, ultrasound, or bronchoscopy, should be used.
Don’t forget a chest X-ray to confirm that the ET tube is 2 cm above the carina.
Tubes may become displaced due to movement. Make use of continuous waveform capnography to monitor for tube dislodgement.
Sudden deterioration in any intubated patient, always think DOPE:
D- Displacement
O- Obstruction
P- Pneumothorax
E- Equipment failure
ACEP // Verification of Endotracheal Tube Placement. https://www.acep.org/patient-care/policy-statements/verification-of-endotracheal-tube-placement/
Disclaimer: This post is for educational purposes and is not intended as medical advice. While we strive for 100% accuracy, errors may occur, and medications or protocols may change over time.
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