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Verification of Endotracheal Tube Placement

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Verification of Endotracheal Tube Placement Choose a Topic Choose an Activity Clinical Policies Practice Resources > ACEP Policy Statements Focus On: Emergency Airway ACEP Policy Statements Management in the Pregnant Certification & Credentialing Verification of Endotracheal Tube Placement Patient Contracts & Compensation Revised and approved by the ACEP Board of Directors April 2009 Rapid-Sequence Intubation Arrangements Originally approved by the ACEP Board of Directors October 2001 replacing Verification of Endotracheal Tube "Expired Carbon Dioxide Monitoring" approved by the ACEP Board of Directors in Disaster Preparedness and Placement Response September 1994 and rescinded October 2001 Verification of Endotracheal Tube Diversion As an adjunct to this policy statement, ACEP's Clinical Policies Committee Placement developed a Policy Resource Education Paper (PREP), Verification of EMS Endotracheal Tube Placement. Ethics View All Airway The American College of Emergency Physicians endorses the following principles Health Care Delivery Policies regarding the confirmation of endotracheal tube placement in the emergency department or in the out-of-hospital setting. Health System Reform Policies Confirmation of proper endotracheal tube placement should be completed in all ACEP recommends the following Health Workforce Policies patients at the time of initial intubation. Physical examination methods, such as books and resources: auscultation of chest and epigastrium, visualization of thoracic movement, and Peer VII on CD- Hospitals ROM fogging in the tube, are not sufficiently reliable to confirm endotracheal tube Injury Prevention Policies placement. Similarly, pulse oximetry and chest radiography are not reliable as sole techniques to determine endotracheal tube location. Managed Care Policies During intubation, direct visualization of the endotracheal tube passing through the Medical Education Policies vocal cords into the trachea constitutes firm evidence of correct tube placement, but Mental Health Policies additional techniques should be used to confirm proper endotracheal tube position. Motor Vehicle Injury Prevention End-tidal carbon dioxide detection is the most accurate technology to evaluate Reimbursement Trends and Policies endotracheal tube position in patients who have adequate tissue perfusion. Strategies in Emergency Medicine Pediatric Policy Statements June 1-3, 2009 Esophageal detector devices are not as reliable as end-tidal carbon dioxide Hotel Del Coronado - San Diego, CA determinations for the verification of endotracheal tube placement in patients who Physician Payment Policies Advanced Procedure Coding for have adequate tissue perfusion. Emergency Medicine Physician Well Being Policies June 4-5, 2009 For patients in cardiac arrest, and for those with markedly decreased perfusion, Hotel Del Coronado - San Diego, CA Practice Management Policies end-tidal carbon dioxide determination may be less accurate. In these situations, if the end-tidal carbon dioxide determination is inconclusive, other methods of Professional Liability Policies confirmation should be performed. Public Health Policies Properly placed endotracheal tubes may become displaced due to movement of Substance Abuse Policies patients and/or equipment. Continuous assessment of correct endotracheal tube placement with continuous end-tidal carbon dioxide monitoring is ideal. Violence and Abuse Policies Reconfirmation of endotracheal tube position should be undertaken immediately in Issues By Category all patients when their clinical status deteriorates, or at any time there is concern regarding proper location of the endotracheal tube. EMS & Disaster Preparedness GME Ultrasound imaging and transthoracic impedance methods may prove to be helpful as adjuncts to detect and monitor the proper location of endotracheal tubes. Faculty Development However, the evidence is currently insufficient to endorse widespread Research & EMF implementation of these technologies for this purpose. Careers Print Forward to a Friend Personal Finances Search Advanced Search >> © 2009 American College of Emergency Physicians Privacy Policy | Contact Us |.
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