PEDIATRICS Vol. 56 No. 2 August 1975, pp. 224-229
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Endotracheal Tube Placement in Infants Determined by Suprasternal Palpation: A New Technique

Francis J. Bednarek M.D.1 and Lawrence R. Kuhns M.D.1

1 Department of Pediatrics and Communicable Diseases and the Division of Pediatric Radiology, University of Michigan Medical Center, Ann Arbor

In order to decrease complications of improper endotracheal tube positioning, a method of placing the tube by palpation within the suprasternal notch was devised. The method proved to be simple and effective. The accuracy was verified by fluoroscopy and a clinical study comparing this technique with others is reported. No complications of the technique were noted.

Once palpation was reliable, the proper position of the tube tip was defined. From measurements taken from routine inspiratory chest radiographs on 142 infants, it was found that a point midway between the medial ends of the clavicle (IMP) was a good position because it approximates the true tracheal midpoint and, therefore, is a good landmark on a chest radiograph. This point allows for movement of the tube tip with head positioning and of carina with respiration. The tube tip can be placed near the IMP by the suprasternal palpation technique. This method, therefore, is useful in emergency situations or on initial intubations to avoid improper position of the tube tip prior to radiograph verification.

Submitted on August 16, 1974
Accepted on November 1, 1974




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