How should endotracheal tube placement be verified after intubation?

• A. Pulse oximetry alone is insufficient to confirm placement
• B. Rely only on chest X-ray after several minutes
• C. Capnography waveform confirming CO2, and auscultation for equal breath sounds
• D. Visual estimation of tube depth

Answer: (C)

Immediately after intubation, verify placement with capnography by looking for a consistent end-tidal CO2 waveform. This shows that the tube is in the airway and that there is pulmonary ventilation, which is the fastest and most reliable real-time confirmation that the tube is not in the esophagus. Pair that with auscultation to ensure both lungs are being ventilated evenly and to help detect malposition such as mainstem intubation; together these checks give immediate, actionable feedback.

Relying on pulse oximetry alone cannot confirm where the tube is, because oxygenation can look acceptable even if the tube is misplaced, and it doesn’t tell you about airway placement at all. Chest X-ray after several minutes confirms position but comes too late for urgent decisions and exposes the patient to radiation. Visually estimating depth is unreliable due to anatomical variation and technique, so it’s not a dependable method on its own.

So, using a CO2 waveform to confirm tracheal placement, supplemented by listening for equal breath sounds, provides the quickest and most accurate verification right after intubation.