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 3^rd 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.

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