Bronchial electrocardiography to determine left or right main bronchial placement of an endotracheal suction catheter tip.

Abstract

To assess the utility of a blue lined angle tipped and electrode tipped catheter, to guide left and right main bronchus cannulation. A prospective study. An 11-bed general intensive care unit in a 900-bed teaching hospital. 50 intubated intensive care patients, in sinus rhythm with normal P and QRS mean frontal axis, who required endobronchial suctioning for routine respiratory management. Endobronchial electrocardiography was used to position a blue lined angle tipped and electrode tipped suction catheter into the right and left main bronchi. Selective cannulation of the left main bronchi was determined by observing a biphasic or inverted P wave in 42 patients, or biphasic or inverted QRS complex in 31 patients. In 8 patients in whom no changes in the ECG were found, bronchoscopic placement of an ECG electrode into the left main bronchus demonstrated a biphasic or inverted P wave in 8 patients and a biphasic QRS complex in 3 patients, confirming the failure to cannulate the left main bronchus in these 8 patients. Using a blue lined, angle tipped and electrode tipped catheter for endotracheal suctioning, endobronchial electrocardiography may be a simple method to signal left or right main bronchus cannulation.