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Chest x-ray: ET tube position (summary)

This is a basic article for medical students and other non-radiologists

Endotracheal tube placement is frequently assessed using chest radiography. In adults, the tip of the ET tube should be approximately 5 cm from the carina (approximately halfway between the interclavicular line and the carina).

Changes in position

The position of the ET tube tip is dependent on the position of the head. Most people think that neck flexion will result in elevation of the ET tube tip. However, neck flexion results in depression of the ET tube tip. Conversely, extension of the neck results in elevation of the ET tube tip. Tip position may change by up to 2 cm up or down from neutral position.

Radiographic appearances

  • tip 5 cm above carina
  • width 2/3 tracheal diameter
  • cuff should not expand the trachea

When ET tubes are malpositioned, they most frequently find their way into the right main bronchus with resultant left lung collapse.

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