Clinical audit: optimal positioning of endotracheal tubes in neonates

Scott Med J. 2007 May;52(2):25-7. doi: 10.1258/rsmsmj.52.2.25.


Background: The malposition of endotracheal tubes (ETTs) can be associated with endo-bronchial intubation or accidental extubation. A variety of methods have been reported for predicting insertional length (IL) including weight, nasal-tragus length (NTL) and sternal length (STL) measurements. In our unit no consistent predictor method was being used.

Aim: To audit the proportion of endotracheal tubes that required a significant position change after oral intubation. Our standard set was that the endotracheal tube should be in a satisfactory position in > 80% of cases. If not met, practice would then be re-audited after a consistent predictor method had been implemented.

Methods: Data regarding changes in endotracheal tube position were collected. Significant position changes were defined as adjustments > 0.5 cm.

Results: Twenty two babies were included in the initial audit, and only 73% of endotracheal tubes had a satisfactory position. Thirty six babies were included in the re-audit and when the nasal-tragus length predictor was used, 94% of endotracheal tubes had a satisfactory position, meeting the standard.

Conclusion: The nasal-tragus length predictor improved the accuracy of endotracheal tube positioning after oral intubation. It is a simple, fast, reproducible method and can be used in everyday practice to help avoid significant endotracheal tube malposition.

MeSH terms

  • Female
  • Humans
  • Iatrogenic Disease / prevention & control
  • Infant, Newborn
  • Intubation, Intratracheal / standards*
  • Male
  • Retrospective Studies
  • Treatment Outcome