# Endotracheal Intubation Verification Device



## GlobalHealthStudent (Jan 21, 2016)

Hello everyone! I'm a biomedical engineering student at Northwestern University (USA) who is studying global health technology and medical device design for the developing world. More specifically, we are at the University of Cape Town in South Africa working on a device to verify proper endotracheal intubation without the use of a waveform capnograph.

From what we've read, it seems that waveform capnography is the "gold standard" method of ensuring tracheal intubation, but in many places waveform capnographs are too expensive or unavailable.

Assuming waveform capnography is unavailable, what other methods/devices could be used to ensure tracheal intubation? If you had to come up with an "ideal" tracheal intubation verification device that is both inexpensive and easy-to-use, what would it look like?

So far, we've come up with a system that detects end tidal CO2 (but doesn't produce a waveform, making it significantly cheaper) and responds with an LED light when C02 is detected within the endotracheal tube. Would this be useful/feasible?

Any feedback would be greatly appreciated, especially from emergency service members working outside the "developed" world. We would also be interested in communicating with any EMTs throughout Cape Town and South Africa who would be willing to evaluate our new medical device. 

Thanks for your suggestions and service!

Joe


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## STXmedic (Jan 21, 2016)

This CO2 detector is already commonly used at places that can't or afford or haven't transitioned to waveform capnography:

https://www.boundtree.com/easy-cap-and-pedi-cap-co2-detectors-group-13737-323.aspx?search=530024


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## wanderingmedic (Jan 21, 2016)

STXmedic said:


> This CO2 detector is already commonly used at places that can't or afford or haven't transitioned to waveform capnography:
> 
> https://www.boundtree.com/easy-cap-and-pedi-cap-co2-detectors-group-13737-323.aspx?search=530024



This device is actually still used by many US agencies who don't have capno on their monitors. It has very few drawbacks and is basically idiot proof as long as you're not color blind. Between this, and/or having a monitor with ETCO2 capabilities, there really isn't anything else you could need in the field.


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## wanderingmedic (Jan 21, 2016)

GlobalHealthStudent said:


> So far, we've come up with a system that detects end tidal CO2 (but doesn't produce a waveform, making it significantly cheaper) and responds with an LED light when C02 is detected within the endotracheal tube. Would this be useful/feasible?



Also, remember to consider that ETCO2 is going to be significantly lower during cardiac arrest vs an alive pt. An ETCO2 of 4-10 in an alive patient could indicate esophageal ET placement, while in a cardiac arrest would likely indicate correct tube placement. What parameters were you using to have the light illuminate to indicate CO2?


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## NomadicMedic (Jan 21, 2016)

Or, use a bulb EDD.


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## Tigger (Jan 21, 2016)

It would be nice to have something on the tube itself indicating gas exchange. Moving an intubated patient attached to the monitor is not the biggest deal, but still a pain. A tube in our system was allegedly dislodged recently by the end tidal line going taut and yanking the on it, though that could be prevented by just being more careful.


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## ExpatMedic0 (Jan 24, 2016)

In my humble opinion... I do not think ETI should be performed with out wave form capnography, and I think most up to date peer reviewed medical literature would suggest the same? Color metric devices and bulb syringes are pretty old school and are falling out of favor. I guess to better answer your question with my opinion, I would need to know why waveform capongraphy is to expensive? Is it the companion device, such as a lifepak/defibrillator? Is it the disposable nose prongs or ET tube connector?  Based on that, I could speculate on ideas.


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## Carlos Danger (Jan 24, 2016)

ExpatMedic0 said:


> In my humble opinion... I do not think ETI should be performed with out wave form capnography, and I think most up to date peer reviewed medical literature would suggest the same?



I would generally agree, but I think there are enough exceptions (austere settings, monitor failure, etc.) that other confirmation techniques certainly have a place.

One place I worked we had a small device (about the size of a deck of cards) that was a side stream C02 detector. It didn't show a waveform, but gave a breath-to-breath Etc02 value. It was great for hike-in scenes and trapped patients and other unusual scenarios. It also came in handy as a backup to our monitors. We had the first-generation Zoll CCT monitors at the time, and had a lot of problems with the Sp02 and Etco2.


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## CANMAN (Jan 26, 2016)

Remi said:


> I would generally agree, but I think there are enough exceptions (austere settings, monitor failure, etc.) that other confirmation techniques certainly have a place.
> 
> One place I worked we had a small device (about the size of a deck of cards) that was a side stream C02 detector. It didn't show a waveform, but gave a breath-to-breath Etc02 value. It was great for hike-in scenes and trapped patients and other unusual scenarios. It also came in handy as a backup to our monitors. We had the first-generation Zoll CCT monitors at the time, and had a lot of problems with the Sp02 and Etco2.



Ugh Zoll CCT monitors, did you toss that brick out of the aircraft on purpose?


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## COmedic17 (Jan 26, 2016)

GlobalHealthStudent said:


> So far, we've come up with a system that *detects end tidal CO2* (_but doesn't produce a waveform,_ making it significantly cheaper) and responds with an LED light *when C02 is detected within the endotracheal tube*. Would this be useful/feasible?



So is it just a fancy/more expensive version of the pre-exhisting colorimetric device?


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## Tigger (Jan 26, 2016)

COmedic17 said:


> So is it just a fancy/more expensive version of the pre-exhisting colorimetric device?


Those don't really show realtime though, right? They are good for initial verification, but you I don't think the color can change back? Or maybe it can.


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## COmedic17 (Jan 26, 2016)

Tigger said:


> Those don't really show realtime though, right? They are good for initial verification, but you I don't think the color can change back? Or maybe it can.


No it's just for the one time. 

But if someone is going to dish out money for a tube attachment that can detect co2 continuously, why wouldn't they dish out the money for an attachment that gives an actual reading instead of just lighting up?


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## Tigger (Jan 26, 2016)

COmedic17 said:


> No it's just for the one time.
> 
> But if someone is going to dish out money for a tube attachment that can detect co2 continuously, why wouldn't they dish out the money for an attachment that gives an actual reading instead of just lighting up?


I can see some use for when you're moving the patient as well as some austere settings. We have the ability to intubate someone from our wilderness bags, and the monitor will not be around on those calls. We know the tube is good when it's placed from the colormetric, but what happens when you carry the patient to the LZ? Obviously there are other methods, but if it was a cheap device...


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## COmedic17 (Jan 26, 2016)

Tigger said:


> I can see some use for when you're moving the patient as well as some austere settings. We have the ability to intubate someone from our wilderness bags, and the monitor will not be around on those calls. We know the tube is good when it's placed from the colormetric, but what happens when you carry the patient to the LZ? Obviously there are other methods, but if it was a cheap device...


From a financial standpoint, if you owned a company, would you order a more expensive device for the sake of confirming tube placement after movement? Or would you just tell your crews to use another much cheaper device like another colorimetric device? 

I don't deny that the device the op is talking about would work, I just don't see it being utilized due to the financial aspect of it when there's so many other cheaper methods to detect tube placement. And if a company/department is willing to spend the extra money because they want a continuous co2 reading, I don't see why they wouldn't get a device that produces a reading/waveform that can be used for a variety of other situations as opposed to just intubations.


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## ExpatMedic0 (Jan 27, 2016)

I was under the impression the OP was working on something that looked and acted like a portable SPO2 monitor, ones that are wireless and slip on a finger for example. However, it would spit out a Co2 reading instead of an o2 reading... I am not sure, I would like further information and also why the waveform is not practical and to expensive(component wise).


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## ThadeusJ (Jan 27, 2016)

Like this?
http://www.capnography.com/new/emergency-intubations/72-technology/emergency-intubations


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## ExpatMedic0 (Jan 27, 2016)

ThadeusJ said:


> Like this?
> http://www.capnography.com/new/emergency-intubations/72-technology/emergency-intubations


Exactly.


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## STXmedic (Jan 27, 2016)

ThadeusJ said:


> Like this?
> http://www.capnography.com/new/emergency-intubations/72-technology/emergency-intubations


Well that's kinda cool... Never seen one of those before.


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## Pond Life (Feb 1, 2016)

In our service (SWAST, UK NHS) service we have been using EMMA capnography units for a few years now. The reason we introduced them was as a response to the continual bleating of doctors saying stuff like "well you paramedics can't actually say 100% your tube's in the right place" and therefore your sh*te.
So we have them and we can now prove at every point of care that ventilation was effective. If it isn't then we now have the tool to tell us so and we can rectify issues once we see alterations in readings.
Things we had been using before such as the colour metric units and oesophageal intubation detection devices where just not good enough


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