Paramedic National Registry Practice

What is the best method of checking tube placement?

1. Capnography alone

2. Visualize, bilateral chest rise, and no epigastric sounds

3. Listening for breath sounds only

4. Assessing for abdominal distension

The correct answer is: Visualize, bilateral chest rise, and no epigastric sounds

The best method of checking tube placement is to visualize the insertion, ensure bilateral chest rise, and confirm the absence of epigastric sounds. This approach encompasses multiple aspects that indicate proper placement of an endotracheal tube. When visualizing the insertion, providers can directly observe that the tube enters the trachea and not the esophagus. Bilateral chest rise signals effective ventilation and ensures that air is entering both lungs, which is critical for adequate oxygenation and ventilation. The absence of epigastric sounds is also an important indicator, as it suggests that the tube has not inadvertently entered the stomach, which would lead to ineffective ventilation. In contrast, solely relying on capnography is helpful but not sufficient on its own for confirming tube placement. While capnography can indicate that air is being expelled from the lungs and provides a good measure of ventilation, it should be used in conjunction with other methods to confirm correct tube placement. Listening for breath sounds is also inadequate by itself, as it does not assess whether the tube is positioned correctly without additional confirmation through other means. Additionally, assessing for abdominal distension cannot reliably indicate tube placement since distension can occur for a variety of reasons unrelated to the tube’s position. Thus, the