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UWHC,UWMF,

Policies,Clinical,UW Health Clinical,General Care and Procedures,Procedures

Monitoring Placement of Endotracheal Tubes Outside of the Operating Room and Other Anesthetizing Locations (2.3.34)

Monitoring Placement of Endotracheal Tubes Outside of the Operating Room and Other Anesthetizing Locations (2.3.34) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Procedures

2.3.34


UW HEALTH CLINICAL POLICY 1
Policy Title: Monitoring Placement of Endotracheal Tubes Outside of the Operating
Room and Other Anesthetizing Locations
Policy Number: 2.3.34
Category: UW Health
Type: Inpatient
Effective Date: December 28, 2017

I. PURPOSE

To set clear, safe practice standards for the tracheal intubation process for all patients in the patient care
setting outside of the operating rooms and other anesthetizing locations at the University Hospital (UH),
American Family Children’s Hospital (AFCH) and the American Center (TAC).

II. POLICY ELEMENTS

A. The intubating physician or clinical anesthetist shall be responsible for assessing appropriate placement of
the endotracheal tube.
B. The intubating physician or clinical anesthetist is responsible for verifying endotracheal ventilation of the
patient immediately following intubation.
C. The appropriate placement of the endotracheal tube and appropriate ventilation of the patient immediately
following intubation must, at a minimum, be assessed by auscultation AND a Carbon Dioxide (CO2)
detection. The preferred method for CO2 detection is capnography if available.
D. The intubating physician or clinical anesthetist may delegate the performance of the CO2 assessment to a
respiratory therapist, but must remain in attendance until the results of such an assessment are known.
E. A respiratory therapist shall have authority to perform a CO2 assessment at any time without a physician
order or approval, and the respiratory therapist is required to perform such an assessment whenever there is
doubt about endotracheal ventilation of a patient due to suspicion of inappropriate endotracheal tube
placement. Furthermore the respiratory therapist is required to report immediately to a physician or clinical
anesthetist responsible for the patient whenever the results of a CO2 assessment are negative for the
presence of CO2 in the exhaled gases. Upon receiving a report of negative CO2 in the exhaled gases, the
responsible physician or clinical anesthetist must take appropriate actions and document them in the
medical record.
F. The intubating physician or clinical anesthetist should consider stat chest X-ray, fiber optic bronchoscopy, or
ultrasound as additional methods to assess appropriate placement of the endotracheal tube.
G. The intubating physician or clinical anesthetist, AND the respiratory therapist, must remain in attendance
until appropriate placement of the endotracheal tube and appropriate ventilation of the patient have been
verified in accordance with item (C) above, and the endotracheal tube has been appropriately secured.

III. DOCUMENTATION

A. The intubating physician or clinical anesthetist, AND the respiratory therapist, are required to document in
the medical record that appropriate placement of the endotracheal tube and appropriate ventilation of the
patient have been verified in accordance with item (II.C.) above, and that the endotracheal tube has been
appropriately secured.
B. The intubating physician or clinical anesthetist documents all elements that may be required under UWHC
Policy #4.17, Informed Consent, and UW Health Clinical Policy #2.3.32, Operative, Invasive, and Other
Procedures.

IV. COORDINATION

Author: Director, Respiratory Care Services
Senior Management Sponsor: SVP/CNO
Reviewers: Department of Anesthesiology
Approval committees: Respiratory Care Committee; UW Health Clinical Policy Committee; Medical board
UW Health Clinical Policy Committee Approval: November 20, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is



UW HEALTH CLINICAL POLICY 2
Policy Title: Monitoring Placement of Endotracheal Tubes Outside of the Operating Room and Other Anesthetizing
Locations
Policy Number: 2.3.34

responsible for enforcement of this policy in relation to the facilities and programs that it operates.

V. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VI. REFERENCES

CAPNOGRAPHY OUTSIDE OF THE OPERATING ROOMS. Anesthesiology, January 2013.
VERIFICATION OF ENDOTRACHEAL TUBE PLACEMENT. American College of Emergency Physicians.
January 2016.
UWHC Policy # 4.17, Informed Consent Policy
UW Health Clinical Policy #2.3.32, Operative, Invasive, and other Procedures
UW Health Respiratory Care Services #3.22, Capnography.
UW Health Respiratory Care Services #3.43, Placement, Care & Removal of Endotracheal Tubes.


VII. REVIEW DETAILS
Version: Revision
Last Full Review: December 28, 2017
Next Revision Due: December 31, 2020
Formerly Known as: UWHC Administrative policy #8.57