Endotracheal Tube

1. See Also
   1. Endotracheal Intubation
   2. Rapid Sequence Intubation
   3. Endotracheal Tube
   4. Rapid Sequence Intubation
   5. Advanced Airway
2. Preparation: Cuff
   1. Use cuffed ET Tube for children over age 8 and adults
      1. Low pressure, high volume cuff
      2. Audible air leak on ventilation pressure >20-30cm H20
   2. Previously recommended to use uncuffed ET Tube for children under age 8 years
      1. Normal narrowing at cricoid is "natural cuff"
      2. Cuffed tubes are now routinely used for all ages (aspiration prevention)
         1. Monitor cuff pressure to prevent necrosis at the cricoid ring
         2. To accomodate cuff size, drop uncuffed tube size estimate by 0.5 mm
3. Preparation: Determining Sizes
   1. Internal Diameter (ID)
      1. Newborns
         1. Newborn <28 weeks (<1000 g): 2.5 mm
         2. Newborn 28-34 weeks (1000-2000 grams): 3.0 mm
         3. Newborn 34-38 weeks (2000-3000 grams): 3.5 mm
         4. Newborn >38 weeks (>3000 grams): 3.5 to 4.0 mm
      2. Infant under 6 months: 3.5 - 4.0 mm
      3. Infant under 1 year: 4.0 - 4.5 mm
      4. Child under 2 years: 4.5 - 5.0 mm
      5. Child over 2 years: (Age in years)/4 + 4mm
         1. This estimate is for uncuffed tubes
         2. Cuffed tube sizes should be dropped by 0.5 mm (see above)
      6. Adult Female: 7.0 - 8.0 mm
      7. Adult Male: 8.0 - 8.5 mm
      8. Alternative Method: Length based (Broselow Tape)
   2. Outside Diameter
      1. Estimated by size of child's little (pinky) finger
   3. Distance or Depth of Insertion (from distal tube tip to lip)
      1. Marking at bottom of ET Tube should be at cord level
      2. Estimate: Multiply ET Internal Diameter by 3 centimeters
      3. Newborns ('Tip to Lip' distance = 6 + Weight in Kg)
         1. Prepare by cutting ET Tube to 13 to 15 cm
         2. Weight 1 kg: Insert 7 cm depth
         3. Weight 2 kg: Insert 8 cm depth
         4. Weight 3 kg: Insert 9 cm depth
         5. Weight 4 kg: Insert 10 cm depth
      4. Infant under 6 months: 10 cm
      5. Infant under 1 year: 11 cm
      6. Child under 2 years: 12 cm
      7. Child over 2 years: (Age in years)/2 + 12 cm
      8. Adult: 20-22 cm
   4. Suction catheter to fit within ET Tube
      1. ET Tube 2.5 mm: Use 5 or 6 French Catheter
      2. ET Tube 3.0 mm: Use 6 or 8 French Catheter
      3. ET Tube 3.5 mm: Use 8 French Catheter
      4. ET Tube 4.0 mm: Use 8 or 10 French Catheter
4. Preparation: Estimating other tube sizes based on ET Tube size
   1. Mnemonic: 1 to 2, 2 to 4
   2. ETT x 1 = (Age/4) + 4 cm
      1. Accurate for age over 2 years (see above)
      2. Uncuffed Endotracheal Tube size estimate (subtract 0.5 cm for a cuffed tube size)
   3. ETT x 2 = Nasogastric Tube, Orogastric Tube or Foley Catheter tube size
   4. ETT x 3 = Endotracheal Tube depth of insertion
   5. ETT x 4 = Chest Tube size (maximum)