What is the most reliable method of confirming and monitoring correct placement of an ET tube?

Continuous waveform capnography is regarded as the most reliable method for confirming and monitoring the correct placement of an endotracheal (ET) tube because it provides real-time feedback on the presence of carbon dioxide in exhaled breath. When the ET tube is correctly placed in the trachea, the detector will consistently show a waveform along with corresponding values, indicating effective ventilation and that gas exchange is occurring in the lungs.

This method is highly sensitive and specific for verifying airway placement since it reflects whether the tube is positioned in the trachea, as opposed to the esophagus or other areas. The continuous nature of waveform capnography allows for immediate alerting to any changes, such as dislodgement or incorrect placement, which is vital for patient safety.

While end-tidal carbon dioxide monitoring does involve measuring the amount of CO2 at the end of exhalation, it is often seen as less reliable because it does not provide the visual, continuous waveform that allows for real-time monitoring of the tube's position. In contrast, pulse oximetry is useful for assessing oxygenation but does not confirm proper tube placement. A chest X-ray can confirm tube placement but does so after the fact, and does not provide immediate feedback or monitoring