Endotracheal Tube

1. 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. Use uncuffed ET Tube for children under age 8 years
      1. Normal narrowing at cricoid is "natural cuff"
2. 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
      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
      1. Marking at bottom of ET Tube should be at cord level
      2. Estimate: Internal Diameter x3 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