The intubation depth marker: the confusion of the black line

Abstract

For optimal placement we can rely on various formulae and manufacturers' markings on the TTs. Clinical judgement, however, remains the cornerstone of optimal placement.

Tube tip and cuff position using different strategies for placement of currently available paediatric tracheal tubes

“…2 Inadequately placed or absent intubation depth marks could lead to critical tracheal tube tip positions, with an increased risk of either accidental bronchial intubation or extubation. 3 Inadequate position, length of the tracheal tube cuff mounted on the tracheal tubes, or both could result in placement of the tracheal tube cuff in the subglottic or even in the supraglottic region. 4 Evidence exists that many cuffed paediatric tracheal tubes do not fit the paediatric anatomy, and manufacturers were urgently asked to improve their cuffed tracheal tubes for paediatrics.…”

Pediatric cuffed endotracheal tubes

“…Also, depth markings on different CETTs are either missing or are too high up on the shaft of the tube. [30] Thus, the cuff would lie between the vocal cords or even in the sub-glottic space if the tubes are placed according to age – related formulae for predicting depth of tube insertion. Ideally, the cuff should be located below the cricoid ring at the level of tracheal rings to avoid sub-glottic mucosal injury and its sequlae [Figure 2].…”

Distances from vocal cords to mid‐trachea for optimizing endotracheal tubes depth markers according to gestational age

“…Distances from ETT tip to marker line vary considerably between brands and even between tubes from the same company: Distances ranging from 15 to 28 mm were reported in uncuffed 2.5 mm ETT. [6][7][8][9] This variability is a potential cause of hazard when working with different ETT brands 10,11 or in transport.…”