Would you pull the tube? – Poll results & discussion

would you pull the tube

Surprise you?
Probably not, but it surprised me.
The audio recording demonstrated a real issue..in fact a couple. Firstly the fact the capnography had not been checked prior to RSI..yes I know..a checklist may have helped !

Secondly, the dilemma as to how to confirm tracheal tube placement, what is best approach and what to do if not sure? i.e pull tube out and start again.

In fact after debrief of the RSI, the intubator told me that he had seriously considered pulling tube out and starting again for fear of an oesophageal intubation. Such is our reliance on capnography these days! is that such a bad thing? Perhaps. Especially if the tube is in the right place as it was all along and despite my reassurances that I could hear bilateral air entry on lung auscultation. The other obvious thing that could have been done is to repeat DL and have a look!

Capnography is not 100% reliable particularly when it shows absent trace/waveform. If it shows a waveform then if its consistent , its sensitivity is 100% i.e it confirms its in trachea if seen. If its absent, it can mean unfortunately either way! The point is have multiple methods to confirm tracheal tube placement : auscultation, direct visualisation of larynx after ETI placement, ultrasound and capnography.

Dont pull the tube just cause you dont have a capnographic trace/colour change, particularly if you got a good laryngeal view! And always check your capnography before you embark on RSI!

check out these papersĀ if you dont believe me!

CAPNOGRAPHY ALONE IS IMPERFECT FOR ENDOTRACHEAL TUBEĀ PLACEMENT CONFIRMATION DURING EMERGENCY INTUBATION

Assessment and confirmation of tracheal intubation when capnography fails: a novel use for an USB camera.

 

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