title: Clinical audit: optimal positioning of endotracheal tubes in neonates.
abstract: BACKGROUND
  The malposition of endotracheal tubes (ETTs) can be associated with endo-bronchial intubation or accidental extubation. A variety of methods have been reported for predicting insertional length (IL) including weight, nasal-tragus length (NTL) and sternal length (STL) measurements. In our unit no consistent predictor method was being used.
  
  
  OBJECTIVE
  To audit the proportion of endotracheal tubes that required a significant position change after oral intubation. Our standard set was that the endotracheal tube should be in a satisfactory position in > 80% of cases. If not met, practice would then be re-audited after a consistent predictor method had been implemented.
  
  
  METHODS
  Data regarding changes in endotracheal tube position were collected. Significant position changes were defined as adjustments > 0.5 cm.
  
  
  RESULTS
  Twenty two babies were included in the initial audit, and only 73% of endotracheal tubes had a satisfactory position. Thirty six babies were included in the re-audit and when the nasal-tragus length predictor was used, 94% of endotracheal tubes had a satisfactory position, meeting the standard.
  
  
  CONCLUSIONS
  The nasal-tragus length predictor improved the accuracy of endotracheal tube positioning after oral intubation. It is a simple, fast, reproducible method and can be used in everyday practice to help avoid significant endotracheal tube malposition.
authors.affiliation: Neonatology Department, Princess Royal Maternity Hospital, 16 Alexandra Parade, Glasgow G31 2ER, UK. karen.whyte@talk21.com
authors.forename: K L
authors.initials: KL
authors.lastname: Whyte
authors.forename: R
authors.initials: R
authors.lastname: Levin
authors.forename: A
authors.initials: A
authors.lastname: Powls
mesh_terms: D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000592:standards*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome