Endotracheal tube verification in adult mechanically ventilated patients

Abstract

Objective. To explore the methods that can be used to verify endotracheal tube (ETT) placement in adult mechanically ventilated patients.Methods. An integrative literature search was conducted in 2012 -2013 of research citations published in English on the topic of discussion. Electronic databases searched were: the Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, PubMed, the Joanna Briggs Institute (JBI) systematic review library, the Cochrane Library and the National Guidelines Clearinghouse. In addition, reference lists of articles, conference summaries and hand searching was performed. Citations were selected based on the inclusion and exclusion criteria as decided upon by the researchers. The process of critical appraisal was done by the researchers as well as an independent reviewer, all skilled in the research methodology and subject matter related to the topic of discussion. A total of 45 articles were included for critical appraisal. On completion of the critical appraisal, which was done by two independent reviewers, 34 articles were excluded and 11 articles were included in the integrative review analyses. Data were extracted following the critical appraisal process. Owing to the heterogeneity of studies, a metasynthesis could not be done. Results. Based on the reviewed studies, various methods have been identified to verify ETT placement in adult mechanically ventilated patients, namely ultrasonography, the use of centimetre scale printed on the ETT, manual cuff palpation, bilateral auscultation of chest and palpation of symmetrical chest movements, oesophageal detector devices, visualisation of the ETT, use of chest X-ray, pulse oximetry and capnography. Both ultrasonography and capnography had excellent sensitivity and specificity in verifying ETT placement. Conclusion. Although there are various methods reported for ETT verification, the review results recommended ultrasonography and capnography as the most accurate and reliable verification methods.

Endotracheal Tube Nursing Care: Current Evidence

“…Chest radiography has been suggested as a rapid confirmative tool for ETT proper position (Schmolzer & Roehr, 2014). It was emphasized that the golden tools for ETI proper confirmation are through using manufactured devices as capnography for detection of end-tidal carbon dioxide (EtCO 2 ) (Sun et al, 2014) and pulse oximeters that measure the hemoglobin saturation (Das, Choupoo, Haldar, & Lahkar 2015;Jordan, Ham, & Fataar, 2015). Other methods for ETT confirmation include direct palpation of the suprasternal notch, manual cuff palpation, auscultation of chest and palpation of symmetrical chest movements, and esophageal detector devices (Jordan et al, 2015).…”

Chula Formula is recommended in Estimating the Length of Tracheal Tube Insertion in Patients Receiving Mechanical Ventilation in Intensive Care Units in the Absence of Chest X-Ray

“…1 A retrospective cohort study from six states in the US reported that of 6.469.674 hospitalizations, 180.326 (2.8%) received invasive mechanical ventilation. 2 Tracheal intubation is one of the most important and most commonly performed procedures in anesthesiology, emergency medicine, and critical care. 3 The wrong insertion placement of the tracheal tube (TT) causes some complications in the airway.…”