Tracheal tube fixation: the effect on depth of insertion of midline fixation compared to the angle of the mouth.

Following successful placement of a tracheal tube (TT), it is frequently moved from the midline to the angle of the mouth. This study investigates the tracheal tube tip position in the two fixation positions in 200 adult patients. Following tracheal intubation, a fibreoptic bronchoscope (FOB) was introduced through a swivel connector and the distances from the swivel connector to the lips, carina, tip of TT and the crico-tracheal membrane were measured with the TT in the midline and at the right angle of the mouth. The mean (SD) TT tip to carinal distance decreased from 3.60 (1.50) cm to 2.28 (1.55) cm in female patients, and 5.04 (1.43) cm to 3.69 (1.65) cm in male patients on moving the tracheal tube to the angle of the mouth. We conclude that there is a significant movement of the tracheal tube towards the carina on moving the TT from midline to angle of mouth and the depth of insertion of the tube should be adjusted accordingly.