1313 Endotracheal Tube Size and Placement in Neonates

Abstract

Introduction: In neonates, accurate endotrachealtube (ET) size and placement is essential foradequate ventilation and surfactant delivery. Malposition of ET may cause asymmetricalsurfactant distribution, pneumothorax, trachealoesophageal perforation and aspiration.Objectives: To assess: 1)ET placement 2)knowledge of correct ET placement and size inneonates.Methods: 1. Chest X-rays (CXRs) of intubated infants werereviewed and verified by consultant radiologist Jan-Mar 2010. 2. Questionnaires were distributed to consultants, NCHDs and NICU nurses in Rotunda and nationallyduring a week of duty in National Neonatal TransportService. When 2 answers were selected, bothsmaller ET size and shorter ET length was chosen. Results: 1. In total 203 CXRs were reviewed. 70% showedETs were placed in the upper and middle 3rd of thetrachea. Only 4% ETs were placed in the right mainbronchus. No major complications noted. 2. In total 51 questionnaires were completed, 31from tertiary unit and 20 from peripheral. Fromtertiary hospital, all consultants answered correctly,10/13 NCHDs and 8/14 NICU nurses answeredcorrectly. From the peripheral hospitals, allconsultants answered correctly, 6/15 NCHDs and1/3 NIU nurses answered correctly. The variance of answers were found to fall under 3 groups :500g-1000g, 1500g-2000g & 32-34wks. Conclusions: 1. Comparing the ET placement in CXRsbetween gestation and weight, this studyshowed that gestation was more accurate. 2. The knowledge of correct ET size & placement needs improvement. 3. We suggest table of ET size and lengthagainst gestation and weight should beeasily accessible.