Digital palpation of endotracheal tube tip as a method of confirming endotracheal tube position in neonates: an open‐label, three‐armed randomized controlled trial

OBJECTIVE: To compare the malposition rates of endotracheal tubes (ETTs) when the insertional length (IL) is determined by a weight-based nomogram versus when IL is determined by palpation of the ETT tip. DESIGN: Open-label, randomized controlled trial (RCT). SETTING: Level III neonatal intensive care unit (NICU). SUBJECTS: All newborn babies admitted in NICU requiring intubation. INTERVENTIONS: Subjects were randomly allocated to one of three groups, wherein IL was determined by (i) weight-based nomogram alone, (ii) weight-based nomogram combined with suprasternal palpation of ETT tip performed by specially trained neonatology fellows, or (iii) combination of weight-based and suprasternal methods by personnel not specially trained. PRIMARY OUTCOME: Rate of malposition of ETT as judged on chest X-ray (CXR). RESULTS: Fifty seven babies were randomized into group 1(n = 15), group 2 (n = 20), and group 3 (n = 22). The proportion of correct ETT placement was highest in group 2, being 66.7%, 83.3%, and 66.7% in groups 1 through 3, respectively (P value = 0.58). No complication was attributable to palpation technique. CONCLUSION: Suprasternal palpation shows promise as a simple, safe, and teachable method of confirming ETT position in neonates.