What is the recommended action to confirm proper placement of an endotracheal tube after observing symmetrical chest rise?

• A. Auscultate breath sounds
• B. Order a chest radiograph
• C. Attach a color-changing CO2 detector to the end of the ET tube
• D. Obtain an arterial blood gas

Answer: (B)

To confirm proper placement of an endotracheal tube, auscultating breath sounds is essential. This is the immediate and practical action to verify that the tube is correctly positioned within the trachea and not in the esophagus or bronchus. When you listen for breath sounds over the lungs, you should hear clear bilateral breath sounds if the tube is correctly placed. Additionally, checking for equal expansion of the chest indicates that air is entering both lungs effectively.

Ordering a chest radiograph, while useful for more definitive confirmation and assessing for complications, is not the initial recommended action right after observing symmetrical chest rise. It involves waiting for imaging, which isn't necessary if immediate bedside assessments can provide the needed information. Similarly, attaching a color-changing CO2 detector can help confirm placement based on the presence of exhaled carbon dioxide, but this method isn't always available or practical, especially in emergency situations. Obtaining arterial blood gas would be inappropriate for immediate verification of ET tube placement, as it measures oxygen and carbon dioxide levels in the blood but does not provide direct evidence of tube placement. Thus, auscultating breath sounds remains the best first step when confirming the placement of an endotracheal tube.