From the Guidelines
Endotracheal tube placement above the carina is correct, with the catheter tip recommended to be at least 0.5 cm above the carina in small infants and at least 1.0 cm above the carina in older/larger infants, as stated in guideline R 10.14 1. This recommendation is based on the guidelines for pediatric parenteral nutrition, which emphasize the importance of proper catheter placement to avoid complications such as pericardial effusion/tamponade.
Key Considerations
- The guidelines recommend that the catheter tip should lie outside the pericardial sac to avoid the risk of pericardial effusion/tamponade 1.
- The distance of the catheter tip from the carina is crucial, with a recommended distance of at least 0.5 cm in small infants and at least 1.0 cm in older/larger infants 1.
- Proper positioning of the endotracheal tube is essential to ensure effective ventilation and prevent complications.
Verification of Tube Position
- Auscultation of bilateral breath sounds and observation of symmetric chest rise can help confirm proper tube placement.
- Chest X-ray is the gold standard for verifying the exact position of the tube relative to the carina.
- Regular reassessment of tube position is necessary to prevent migration and ensure ongoing effective ventilation. The provided evidence does not directly address endotracheal tube placement in adults, but the principles of proper catheter placement and verification of tube position can be applied to both pediatric and adult populations.
From the Research
Correct Placement of Endotracheal Tube
The correct placement of an endotracheal (ET) tube is crucial to prevent complications such as endobronchial intubation and vocal cord trauma.
- The placement of the ET tube above the carina is considered correct, with the ideal position being approximately 5 cm above the carina 2, 3.
- A study published in the Korean journal of anesthesiology in 2012 found that a new topographical method for endotracheal tube positioning relative to the carina allowed for more frequent placement of the ET tube tip between 3 cm and 5 cm above the carina 4.
- Another study published in Anesthesiology in 2009 found that the airway length from the upper incisor to the carina in the neutral position can be predicted by the straight length from the upper incisor to the manubriosternal joint in the fully extended position, allowing for individualized prediction of the correct depth of an endotracheal tube 5.
- The use of point-of-care ultrasonography has also been proposed as a useful tool for confirming endotracheal tube placement and positioning within the trachea 6.
- Chest x-ray is a reliable method for demonstrating correct positioning of the ET tube, particularly in ICU patients 2.
- The distance from the tip of the ET tube to the carina can be measured using a fiberoptic bronchoscope, and the tube can be positioned properly at the right mouth corner 4.