Endotracheal tube location verified reliably by cuff palpation

To verify a safe location of the endotracheal tube (ETT), palpation of the ETT at the sternal notch is a time-honored technique: After anesthetic induction and confirmation of orotracheal intubation, the patient's head is placed in a neutral position. The ETT is withdrawn or advanced while gentle, repetitive pressure is applied with the fingers at the level of the suprasternal notch. Simultaneously, the pilot balloon is held in the other hand. When the balloon distends from the pressure applied at the notch, the ETT is secured. We tested the efficacy of this technique in men and women who underwent general anesthesia. After the ETT was secured, the distance (in cm) from its tip to the upper incisors, that is, the length of ETT inserted, was measured to confirm its location relative to the carina. The study population consisted of 44 women and 38 men (n = 82) who ranged in age from 16 to 85 yr and in ASA physical status from I to IV. The size of the ETT tube for women ranged from 7.0 to 8.0 and for men, 7.0 to 8.5. Average distance from the tip of the ETT to teeth in women was 20.2 cm (range, 17-23) and in men 21.9 cm (range, 19-25). Average distance to the carina in women was 3 cm (range, 2-5) and in men 3.4 cm (range, 2-6). In this study, palpation of the ETT cuff effectively confirmed ETT location. The technique, which should not be used to verify endotracheal rather than bronchial intubation, should decrease the risk of bronchial intubation or impingement on the carina.