Fundamentals of Nursing Q 582
A client is subjected to undergo a chest x-ray to confirm the endotracheal tube placement. The tube should be how many centimeters above the carina?
A. 2-4 cm.
B. 1.5-3 cm.
C. 1-2 cm.
D. 0.5-1 cm.
Correct Answer: C. 1-2 cm.
Placement of an endotracheal tube is confirmed by a chest x-ray and the correct placement is 1 to 2 cm above the carina. Check patient’s chest x-ray for tube placement and presence of C02 per ET C02 detector after any new intubation; auscultate chest for equal breath sounds bilaterally, and adjust E.T. tube for proper placement.
Option A: Check tube placement with each ventilator assessment. The optimal placement for the endotracheal tube is 2-3cm above the carina in adults. If repositioning of the endotracheal tube is warranted, suction the tube and then suction the oropharynx.
Option B: Positioning the ET tip 4 cm above carina as recommended will result in placement of tube cuff inside cricoid ring with currently available tubes. Optimal depth of ET placement can be estimated by the formula “(Height in cm/7)-2.5.”
Option D: It is suggested that the tip of ET should be at least 4 cm from the carina, or the proximal part of the cuff should be 1.5 to 2.5 cm from the vocal cords. Considering that the length of trachea, as well as the distance from teeth to vocal cords, is variable, securing ET at a fixed length will result in endobronchial intubation or endolaryngeal placement of the ET cuff in some patients.