Confirming Endotracheal Tube Position

• Confirm visual position of the tube

  • Usually measured to incisor or lips​

  • Normally 22 - 24cm

    • There should be a documented level on insertion​

      • Unfortunately not always the case​

• Confirm position on CXR

  • Should lie 2-3 cm above the carina​

    • Measure using ruler function on synapse​

    • This position allows 1-2 cm movement of tube with neck flexion/extension without risk of migrating too far out or too far in

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• ETT too distal

  • For example:

    • Endobronchial intubation​

      • More commonly R main bronchus​

      • May be in left main bronchus

    • Lying against carina

  • Discuss with ICU registrar or consultant

  • Measure distance ETT must be withdrawn

    • Ask bedside nurse to withdraw ETT by that amount​

  • Repeat CXR is usually not required

  • Document new visual level

• ETT too proximal

  • Discuss with ICU registrar or consultant​

  • Measure distance ETT must be advanced

    • Ask bedside nurse to advance ETT by that amount​

  • Repeat CXR is usually not required

  • Document new visual level