Page 186 - 2023 SMOG Digital

AIRWAY CONFIRMATION

CLINICAL INDICATIONS:
• Post endotracheal intubation to confirm proper placement of endotracheal tube (ETT)
CONTRAINDICATIONS:
• None
PROCEDURE:
• Primary / First confirmation of proper placement is always good visualization of tube passing through
cords.
• Provider or second individual should listen for bilateral breath sounds and absence of gastric sounds. Also
evaluate for equal chest rise. Look for ETT fogging.
• Ensure ETT is at appropriate depth and good pilot cuff tension is present.
• WAVEFORM CAPNOGRAPHY is gold standard for patient airway monitoring.
• Capnometer: Place onto ETT and bag patient 2-3 breaths. Proper placement will result in color change to
Gold/Yellow. Esophageal placement will result in a purple color. (Gold=good, Barney=bad) Change will
only occur with perfusion (e.g. High quality CPR required.)
• Esophageal detection device: Squeeze bulb expressing all air out of the EDD. Place this onto end of ETT.
Rapid refilling suggests proper placement (the rigid trachea does not collapse and therefore there is no
obstruction to air return). Poor filling or no filling suggests improper placement (the flaccid esophagus will
collapse around ETT preventing refilling).
• Pulse oxygenation: After a short delay (30-60 seconds in young children, particularly those with poor
perfusion), the pulse oxygenation should increase to normal range (this is not reliable in excessively cold
patients, methemoglobinemia, or CO poisoning). Do not extubate if other confirmation measures say it is
in!
Document procedure, results, and vital signs.

At any time, doubt as to correct placement should prompt removal of tube, oxygenate with
BVM, and re-attempt with BIAD before rescue airway!

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