Keywords
middle fingertip to Rascette line measurement
orotracheal intubation
Rascette line or wrist line
How to Cite
Abstract
The fundamental responsibility of an anesthesiologist is to establish airway patency during general anesthesia to ensure adequate ventilation and oxygenation. Incorrect placement of the endotracheal tube, over or under-insertion, is associated with serious complications. Determining the correct depth of the endotracheal tube is crucial and should be individualized. This study aims to determine if middle fingertip (MFT) to Rascette line (RL) or “wrist line” measurement correlates with acceptable endotracheal tube (ET) depth during orotracheal intubation. This was a prospective, analytical cross-sectional pilot study design. The measured distance from the MFT to RL (cm) of each patient corresponds to predetermined ET depth. After intubation, a chest xray was performed to measure the distance of the ET tip from the carina. The average MFT to RL measurement for Filipinos was 18.79cm (± 1.08) with a mean value of 19.81cm (± 0.99) in males and 18.28cm (± 0.70) in females. Utilizing the MFT to RL measurement, the overall mean distance of the ET tip from the carina was 3.17cm (±1.25), 2.91cm (±1.22) in females, and 3.66cm (±1.36) in males. This was within the acceptable distance of 2-5cm to ensure safe ET placement in the trachea. Out of 54 patients, 85.19% had ET tips 2-5cm away from the carina and 96.29% with ET tips positioned ≥1cm above the carina. In conclusion, MFT to RL measurement is an acceptable technique to determine endotracheal tube depth during orotracheal intubation and estimate correct ET placement in the trachea.
References
American Society of Anesthesiologists. (2020). Standards for Basic Anesthetic Monitoring. https://www.asahq.org/standards-and-practice-parameters/standards-for-basic-anesthetic-monitoring.
Amos, L. Pena, E.D, Sarcilla, D.J, Perez, P., Wong, J.C, & Khan, F.A, (2018). Ideal length of oral endotracheal tube for critically ill intubated patients in an Asian population: Comparison to current western standards. Cureus.10 (11), e3590, 14
ASA Physical Status Classification System, Committee of Oversight, Approved by the American Society of Anesthesiologist; House of Delegates on October 15, 2014, and last amended on October 23, 2019.
Brunel, W., Coleman, D.L., Schwartz, D.E., Peper, E., & Cohen, N.H. (1989). Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position: Chest. 96(5), 1043-5.
Choi, B.R., Lee, S.Y., Chung, J.Y., Park, S.W., Kang, W.J., & Kang, J.M. (2012) Comparison of two topographical airway length measurements in adults. Korean Journal Anesthesiology. 63(5),409–412
Conrardy PA, Goodman LR, Lainge F, & Singer MM. (1976). Alteration of endotracheal tube position. Flexion and extension of the neck. Journal Critical Care Medicine, 4, 7–12.
Evron S, Weisenberg M, Harow E, Khazin V, Szmuk P, & Gavish D, (2007). Proper insertion depth of endotracheal tubes in adults by topographic landmarks measurements. Journal Clinical Anesthesia, 19, 15–9.
Goodman, L.R., Conrardy, P.A., Laing, F., & Singer, M.M. (1976). Radiographic evaluation of endotracheal tube position. American Journal of Roentgenology, 127, 433–4.
Kim J.T, Kim H.J,Ahn W, Kim, H.S, Bahk, J.H, Lee, S.C. (2009). Head rotation, flexion, and extension alter endotracheal tube position in adults and children. Canadian Journal of Anesthesiology. 56:751–756.
Kumari, S., Prakash, S., Mullick, P., Guria, S., & Girdhar, K.K. (2019). Clinical implications of vocal cord-carina distance and tracheal length in the Indian population. Turkish Journal of Anaesthesiology and Reanimation. 47(6), 456-63.
Lee, B.J., Yi, J.W., Chung, J.Y., Kim, D.O., & Kang, J.M., (2009). Bedside prediction of airway length in adults and children. American Society of Anesthesiologists, 111, 556–60.
Mukherjee, S., Ray, M., & Pal, R. (2014). Bedside prediction of airway length by measuring upper incisor manubrio-sternal joint length. Journal of Anaesthesiology Clinical Pharmacology, 30(2), 188–194.
Ong, K., A’Court, G.D., Eng, P., & Ong, Y.Y. (1996). Ideal endotracheal tube placement by referencing measurements on the tube. Annals of the Academy of Medicine, Singapore. 25(4), 550-2.
Park, S., Kim, C., & Jung, I. (1996). Metric Study of Upper Airway and Trachea in Normal Korean Adults using Fiberoptic Bronchoscopy: Study of endotracheal tube fixation positioning in adults. Department of Anesthesiology, Korea Cancer Center Hospital, Seoul, Korea. Korean Journal of Anesthesiology, 31(6), 733-738
Roberts, J., Spadafora, M., & Cone, D. (1995). Proper depth of placement of endotracheal tubes in adults prior to radiographic confirmation. Academic Emergency Medicine, 2, 20-24.
Miller, R. D., Eriksson, L., Fleisher, L., Wiener-Kronish, J., Cohen, N., Young, W. (2015). Miller’s Anesthesia, 8th ed, Elsevier Saunder, 533
Sitzwohl, C., Langheinrich, A., & Schober, A. (2010). Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements. Randomized Trial. BMJ. 341, c5943.
Techanivate, A., Kumwilaisak, K., & Samranrean, S. (2005). Estimation of the proper length of orotracheal intubation by Chula formula. Journal of the Medical Association of Thailand. 88(12),1838-46
Varshney M., Sharma K., Kumar R., & Varshney P.G. (2011). Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients. Indian Journal of Anesthesia, 55, 488-493.
Yao, K. (2009). A formula for estimating the appropriate tube depth for intubation. Anesthesia Progress, 66(1): 8–13.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2024 WVSU Research Journal