How far to put the tube in?

[Giobobo1]

How far do you put the ETT tube in?

 

[DesertMedic66]

Until the black line is at the vocal cords. It depends on age, height, and gender of the patient. With female patients you typically use a smaller tube and it is placed less deep than with a male patient.

From my limited number of intubations it seems 20-24cm is pretty common.

 

[captaindepth]

3x the size of the tube is a good place to start (7.0 tube x 3 = 21cm). Most importantly you want bilateral lung sounds, if you only have lung sounds on the right the tube is probably in the right main stem and needs to be pulled back a bit.

 

[ThadeusJ]

...as well as bilateral chest expansion once you've confirmed the ETT is in the trach and not the esophagus and start bagging.

 

[D Brim]

My first couple of field intubations I was just so excited to see cords I sunk that tube deep down, and didn't even notice until I sat back up and thought "huh, I don't think the BVM adapter is supposed to be at the lips." Don't do that

Once that black line is past the cords, that's deep enough. You just want that cuff past the cords so it doesn't push on them when inflated, but not so deep you are in danger of a mainstem intubation. The formulas and numbers mentioned above are perfect estimates, but of course the point is to intubate to the appropriate anatomical depth. The estimates are just guidelines about what to expect that depth to be.

 

[Accelerator]

As my instructor once told me never go past Christmas (25cm).

Once I see the cuff pass the chords I go maybe one or two cm further. It usually is around 20-23 cm.

 

[COmedic17]

Until you visualize the cuff passing the vocal cords And the black like is right inside/right aside the cords. Everyone is a little different anatomically so you won't get the same measurement at the teeth for everyone.


Also- if you hear bilateral breath sounds prior to intubation- but unilateral after intubation- you most likely did a mainstem intubation. Deflate the cuff and pull back. DO NOT pull the cuff back without deflating the tube and DO NOT needle decompress the patient. I have heard of people doing both of these and it never ends well for them.

 

[COmedic17]

As my instructor once told me never go past Christmas (25cm).

Once I see the cuff pass the chords I go maybe one or two cm further. It usually is around 20-23 cm.

I intubated a person with Marfan syndrome before and it was past 25.

Never set a limit to anything, there's exceptions to everything.

 

[Accelerator]

I intubated a person with Marfan syndrome before and it was past 25.

Never set a limit to anything, there's exceptions to everything.

There are exceptions of course. It is a good rule for new medics and medic students to keep in mind however.

 

[COmedic17]

There are exceptions of course. It is a good rule for new medics and medic students to keep in mind however.

The better rule is to only advance until the cuff fully passes the cords, as opposed as giving it an exact numerical value.

 

[Carlos Danger]

I never even look at the depth of the ETT. I place the balloon just past the cords, inflate the balloon, and tape it down. Done. If it's a tougher intubation and I didn't have great visualization, then I'll confirm with misting, chest rise, and Spo2 before I tape it. But either way I pay zero attention to the cm markings.

It is a good habit to make a note of the tube depth, either after you intubate yourself or when picking up an intubated patient for transfer. It should be part of your post-intubation reassessment, or part of your initial assessment of an intubated IFT patient. I've just never been good about it personally.

That said, it's important to know the normal distances (20-22 cm for adult females and 22-24 for adult males), because that's just part of the basic airway anatomy that you should have a good grasp of if you are going to go running around intubating people. Akin to knowing the mechanism of action and contraindications of any drug you carry.

 

[Accelerator]

The better rule is to only advance until the cuff fully passes the cords, as opposed as giving it an exact numerical value.

That rule doesn't work well if you are using blind or partially blind insertion techniques. Intubation through a SALT airway, etc. You have to monitor the depth of your tube. You're not going to be able to visualize the chords every intubation.

 

[Carlos Danger]

That rule doesn't work well if you are using blind or partially blind insertion techniques. Intubation through a SALT airway, etc. You have to monitor the depth of your tube. You're not going to be able to visualize the chords every intubation.

That is a good point - another reason to know the normal depths.

The only blind intubations I do are over a bougie. Personally, I still don't look at tube depth on those ones, I guess I've done it enough that i just know when it looks like it's where it should be.