Routine chest radiographs following repositioning of endotracheal tubes are necessary to assess correct position in pediatric patients.

Attempts to correctly reposition endotracheal tubes (ETTs) are not always successful in pediatric patients, even when chest radiographs (CXRs) are measured to determine the distance that the ETT deviates from the correct position. We determined the frequency of continued ETT malposition after repositioning in a pediatric intensive care unit (PICU). Forty children with malpositioned ETTs were identified during a 4-month period. After repositioning, ten (25 percent) continued to be malpositioned on the next CXR. Of 47 children with correctly positioned ETTs, only one ETT (2 percent) was found to be incorrectly positioned on the next routine CXR obtained 24 h later. The difference in frequency of ETT malposition between these two groups of children is significant (p < 0.0001). The children were similar in weight and age. Despite repositioning based on measurements taken from a CXR, a large percentage of pediatric patients had continued ETT malposition. However, after radiographic documentation of correct position, we demonstrated that significant movement was uncommon. Routine confirmation of ETT position by CXRs should be considered after repositioning ETTs in pediatric patients.