The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

PRELIMINARY REPORT OF A QUALITY IMPROVEMENT PROJECT TO ASSESS THE REPRODUCIBILITY OF MEASUREMENTS OF ETT POSITION IN PEDIATRIC PATIENTS.

Kevin Cleary, John W. Salyer; Respiratory Therapy, Seattle Children's Hospital and Research Institute, Seattle, WA

INTRODUCTION: One technique for assessing ETT position in infants & children is measuring the distance from the intersection of the ETT and lip or nose to the cut end of the endotracheal tube. We sought to determine the reproducibility of these measurements. METHODS: Three different respiratory therapists (RT's) independently measured these distances on a convenience sample of intubated patients in our NICU/PICU/CICU. Results of measurement were blinded between RT's, and were made using newborn measuring tape (resolution = 0.25 cm). The last charted measurement from the ventilator flow sheet was also noted for a total of 4 measurements. Patients were intubated orally or nasally. For the oral route, we secured ETT's using a specially modified umbilical clamp that has an appropriate sized hole drilled through the center of the clamp through which the ETT is passed. The clamp is then taped to the patients face (Loughead et al. Jt Comm J Qual Patient Saf. 2008 Mar;34(3):164-70). For this route, the measurements were made from the umbilical clamp to the cut end of the ETT. The nasally intubated population is measured from the nasal septum to the cut end of the ETT. Age, weight and ETT size were also noted. Results were classified according to the degree of agreement between the multiple measurements according to the following scheme; if all four measurements agreed = 100% congruent, if 3 of 4 measurements agreed = 75%, if 2 of 4 measurements agreed = 50%, if all 4 measurements were different = 0% congruent, RESULTS: Data were obtained on 13 patients who ranged in age from 1-45 weeks, with a mean (SD) = 12.2 (15.2) weeks. Patient weight ranged from 2.9-6.6 Kg with a mean (SD) = 4.1 (1.3) Kg. ETT sizes included 3 patients with 3.0 mm and 10 with 3.5 mm. Five patients were intubated nasally & 8 orally. Measurement agreement was: 100% congruent = 6 patients (46%), 75% congruent = 3 patients (23%), 50% congruent = 3 patients (23%), 0% congruent = 1 patient (8%). Maximum difference between the longest and shortest measurement on the same patient was 1.5 cm. CONCLUSION: Multiple observers obtained the same measurement of ETT position in less than half of patients. This lack of agreement can potentially lead to poor assessment of ETT position and possibly unnecessary re-taping and or repositioning of ETT. We speculate that a more reproducible measurement system might be possible and intend to explore this idea further. Sponsored Research - None