Fixing Right Mainstem Intubation
ACLS Certification Association videos have been peer-reviewed for medical accuracy by the ACA medical review board.
Article at a Glance
- After intubation, the provider must know how to correct a right mainstem intubation.
- The provider uses sight and sound to determine how far to withdraw the tube.
- The provider listens on the left side and slowly withdraws the ETT until breath sounds are heard
Related Video – Advanced Airways: Endotracheal Intubation
You may have to correct a right mainstem intubation in a case where, hypothetically, an overzealous rescuer buried the endotracheal (ET) tube, and it went into the right lung. The doctor may look at the X-ray and ask you to pull it back two centimeters. While you could simply move it two centimeters, you could also use sight and sound to help guide the ET into a better position. This X-ray image shows a right mainstem intubation. First, look at the size of the ET tube at the hub to get a target range of where you want to be at the patient’s teeth. Next, while someone else bags the patient, take the cuff down, deflate the cuff, and listen to the left side of the chest with a stethoscope as you retract the tube. As you pull the ET tube back, make sure to look at the ET tube markings, ensuring you don’t go past the target range. Pull the tube back until you hear lung sounds. It’s much better to use sight and sound to position the ET tube opposed to randomly pulling it back two centimeters which may possibly extubate the patient. Read: General Stroke Care Pay attention to the target range of the ET tube. Listen to the left lung while pulling the ET tube back.Right Mainstem Intubation
Related Video – One Quick Question: How Do You Calculate Tube Depth?
Nerves are natural during your first code, so initially just stand back, watch, and learn. Your first responsibility during a code will most likely be chest compressions. Make sure to administer them effectively. After the cardiac event, review it to learn and be even more prepared for your next code.Summary
More Free Resources to Keep You at Your Best
Editorial Note
ACLS Certification Association (ACA) uses only high-quality medical resources and peer-reviewed studies to support the facts within our articles. Explore our editorial process to learn how our content reflects clinical accuracy and the latest best practices in medicine. As an ACA Authorized Training Center, all content is reviewed for medical accuracy by the ACA Medical Review Board.
More to Learn
When the patient is stable and the tachyarrhythmia persists, determine if the QRS-complex is narrow or wide for the correct treatment of the patient. Read more in our detailed article.
This article and video explain Diabetic Ketoacidosis (DKA). Learn the etiology, pathophysiology, and the most common signs...