Confirming Endotracheal Tube Placement in Neonates

Hi friends, in this video we are going to discuss some of the ways that endotracheal tube (ETT) placement can be verified in neonatal patients. We are also going to take a closer look at some of the events that happen immediately post-intubation. Some of the most common ways to confirm that the ETT is in the trachea (versus the esophagus) is though color-changing carbon dioxide detectors, chest x-rays, and end-tidal capnography monitoring.
Immediately after intubation, check the tube location at the upper lip using the patient’s weight as a guide for tube depth. ETT can easily be inserted too deeply upon intubation. Next, attach the carbon dioxide detector to confirm color change from purple to yellow. Note that color change might not occur until 6 or more breaths have been given, and color change may not occur at all in patients with poor cardiac output or low/no heart rate (as there is little or no carbon dioxide to detect). In these cases, use additional means to verify placement. While assessing for color change, auscultate for equal breath sounds bilaterally and diminished sounds over the stomach. Visually assess for equal chest rise with each breath, vapor in tube, and improvement in patient color, heart rate, and oxygen saturation. After placement is confirmed, tape and secure the tube per your institution’s policy.
Remember, as you are performing these steps it is vital that the intubator (or other designated person) hold the ETT firmly in place against the infant’s palate to ensure that it doesn’t become dislodged while placement is being confirmed. It is also imperative that the infant continues to be ventilated for the entire duration of time it takes to verify placement.
00:00 Importance of Verifying Placement
00:55 Ways of Verifying Placement in Neonates
01:17 Sequence of Events Post-Intubation
02:50 Carbon Dioxide Detectors
03:28 Caveats With Carbon Dioxide Detectors
04:27 Auscultation to Verify
05:34 Visual Assessment to Verify
06:18 Remember to Ventilate!
07:09 Securing the Device
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This content was peer-reviewed for accuracy by Christine McQuay, MHA, MSHI, BSN, RN, RNC-NIC.
I’m Anna and I am a critical care registered nurse. I have worked in the NICU, PICU, pediatric floor, and on my hospital’s critical care children’s transport service. I am also a nursing instructor and love teaching students and new nurses!
Disclaimer: This video is intended for educational purposes only and is not indented as medical advice. While I strive for 100% accuracy, errors may occur and practices may change over time.

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