10 Questions
What is a potential complication of having the endotracheal tube (ETT) tip placed too deep?
Pneumothorax
What can happen if the endotracheal tube (ETT) is placed too shallow?
Gastric dilatation
If the endotracheal tube (ETT) cuff is inflated between the vocal cords, what complication may arise?
Glottic edema
What percentage of initially placed ETTs are found in the right main stem bronchus?
~10%
How can intubation of the esophagus be recognized?
Marked gastric distension
Where should the tip of the Endotracheal Tube (ETT) ideally be positioned in relation to the carina?
Over T5, T6, or T7
How does neck extension from a neutral position affect the position of the ETT tip?
Causes the tip to ascend
What is the recommended distance between the tip of the ETT and the carina with the head in a neutral position?
5-7 cm
What happens if the ETT cuff bulges significantly within the trachea?
Increased risk of aspiration
What is the recommended width of the ETT in relation to the trachea's diameter?
1/2 to 2/3 width of trachea
Study Notes
Malpositions of the ET Tube
- 15% of all intubations result in malpositions, with emergency intubations having the highest rate.
- Intubation of the esophagus can be recognized by marked gastric distension.
Tip of Tube Too Deep
- 10% of ETTs are initially placed in the right main stem bronchus.
- This can cause the left lung to become atelectatic over time.
- If the patient is on a ventilator, the right lung may become hyperinflated.
- This can lead to pneumothorax or tension pneumothorax.
Tip of Tube Too Shallow
- The tip of the tube should be at least 3 cm distal to the cords.
Complications of ETT
- Edema of the nasal mucosa can cause sinusitis.
- A tube in the pharynx can cause gastric dilatation and aspiration of gastric contents.
- A cuff inflated between the vocal cords can produce glottic edema, which may progress to scarring.
Radiographs and ETT Positioning
- ETT radiographs are obtained routinely after intubation.
- The position of the carina is recognized by a thin white opaque line usually running the length of the tube.
- The position of the carina should be at the level of T5, T6, or T7 in 95% of cases.
- Neck flexion can cause the tip of the tube to descend by 2 cm, while neck extension can cause it to ascend by 2 cm.
- In a neutral neck position, the tip of the ETT should be 5-7 cm from the carina, or about half the distance between the medial ends of the clavicles and the carina.
- The ideal position is for the tube to be ½ to 2/3 the width of the trachea, with the cuff filling but not bulging the lumen of the trachea.
Test your knowledge on the various malpositions of the endotracheal tube (ETT) during intubation, such as esophageal intubation, deep placement in the bronchus, and shallow placement near the vocal cords. Understand the potential consequences of these malpositions and how to identify and correct them.
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