ET Tube "to short???"

MedicPrincess

MedicPrincess

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Today on my roommates 2 yo drowning, her shift supervisor showed up. As he went to attempt to intubate the child with a 4.5 ET Tube, he was unable to successfully do so. As my roommate moved him aside so an airway could be secured, he made the comment:

"The tube is too short."

The child was intubated with a 4.5 by my roommate. Her shift commander refused to discuss it afterwards.

Can someone with please tell me how a tube can be to short? I know the ink has not even been printed on my liscense yet, and the ink on my diploma from the college is still wet...but I thought we chose ET Tubes based on diameter, not length. I also thought if the tube was not in far enough, you just had to advance it a little more.

I understand the emotions thing being pretty high (i never heard my medic literally screaming our orders, until we had our pedi drowning last week), so could this have just been an off statement when he was unable to get the tube?
 
Sounds like B.S. to me. All of the ETT I have used are a standardized size in length. You are correct in the diameter.

I believe someone was attempting to save face, in not being able to intubate. The child was successfully intubated with the tube right?.. Well, it apparently was long enough.

R/r 911
 
Gotta agree...somebody wasn't up on their intubation skills and was making excuses. Bad deal...but at least someone was able to tube the kid.

I really would like to see the person that had such a weird anatomy that an ET tube was really to short for them though.
 
For a 2 year old, 4.5 should be the correct size.

PEDIATRIC:
SIZE: ETT Size = (Age in years/4) + 4 for children over 2 years old
DEPTH: (Age in years/2) + 12 for children over 2 years old

ETTs vary in length for each size by 5 - 30 mm between sizes until 8.0.
ETT size 2.5 = approx 145 mm in length.
ETT size 8.0 = approx 330 mm in length.

I do run into "short" tubes when adults are nasally intubated with a 5.0, 5.5 or 6.0 tube. The cuff is usually resting above, on or in the cords. I've also had adults where their carina and cords have a distance too short to accommondate the "normal" adult sized tube. The cuff again conflicts with the cords. Depending on the reason to intubation, we (RT) may tolerate putting a smaller tube in or consult the ENT/Anestheia closet of specialty tubes available in the hospital.
 
The question I ask Vent, have you ever seen an ETT too short to tube a pediatric? I personally have not seen one, in my years.

R/r911
 
Twice.
Once in facial anomaly precipitated by a pituitary gland disorder. Once with a Down's Syndrome child. That's after a 15 year specialty in Neo/Peds.

Although, I will say kids are not looking their ages anymore.
 
VentMedic said:
Twice.
Once in facial anomaly precipitated by a pituitary gland disorder. Once with a Down's Syndrome child. That's after a 15 year specialty in Neo/Peds.

Although, I will say kids are not looking their ages anymore.
Click to expand...
Just noticed the RRT, great, hey im curious about the pit gland disorder you mentioned. Im assuming there was some sort of bone abnormality to support the tissue being "out of alignment" so to speak. Would you happen to know if it was an enlarged sella turcica to fit the Pit gland that distorted the surrounding phenoid structures? And, is there any typical problems concerning airway in Downs syndrome you could enlighten me on? I havnt had many of those patients, and the ones i did, didnt need any airway care.Thanks.

note*Before Medic, i was a trauma/surgery R.T. (Rad Tech), and still moonlight on occaison when im not overseas.
 
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