FIRST THORACIC VERTEBRAL BODY AS REFERENCE FOR ENDOTRACHEAL-TUBE PLACEMENT

After intubation in newborn infants, the placement of the endotracheal tube in the trachea must be checked by a chest radiograph. The most c ommonly used reference point for placement is the medial ends of the c lavicles. The position of the clavicles may be variable. The present s tudy was carried out to determine whether the body of the first thorac ic vertebra should be used instead of the clavicles because its positi on on chest radiographs is more constant. Seventy eight radiographs ob tained from 35 neonates were examined prospectively. The carina was si tuated between T3 and T5, most commonly at T3-4 or T4 (85%). The posit ion of the clavicles varied markedly from patient to patient and withi n the same patient on different days, and this variation was significa ntly higher than that of the carina. On 65 (83%) examinations the clav icles lay above the first thoracic vertebra. It is recommended that, f or accurate placement within the trachea, the tip of the endotracheal tube should be placed at the level of the body of the first thoracic v ertebra; this could be used as the sole reference point on chest radio graphs obtained in the neonatal period.