How should a respiratory therapist confirm proper placement of an endotracheal tube immediately following intubation?

• A. Assess end-tidal CO2 with a colorimetric capnometer
• B. Ensure tube markings are between 20-24 at the teeth
• C. Auscultate the neck
• D. Obtain an anterior-posterior chest radiograph

Answer: (D)

Confirming proper placement of an endotracheal tube immediately following intubation is crucial for patient safety and effective ventilation. One of the most reliable ways to ensure the tube is correctly positioned in the trachea is to obtain an anterior-posterior chest radiograph.

A chest radiograph allows for visual confirmation that the tube is not positioned in the esophagus but instead in the trachea, which is vital to ensure that the patient is receiving adequate ventilation and oxygenation. The X-ray can also help assess that the tube is not too deep, which could risk entering a mainstem bronchus, or too shallow, which could result in inadequate ventilation.

Although other methods like assessing end-tidal CO2 levels and auscultation are useful for determining placement, they may not be definitive immediately after intubation. For instance, the capnometer can indicate proper placement but is not foolproof in instant verification, especially in certain emergency scenarios. The tube markings can offer initial clues, yet they do not guarantee proper placement without further confirmation. Using a chest radiograph is a comprehensive approach to ensuring that both the position and depth of the endotracheal tube are appropriate before proceeding with patient care.