The nurse is called to assist a 32-year-old G1P0 female who is in active labor with a viable intrauterine pregnancy at 30-weeks estimated gestational age. The patient delivers a neonate who requires intubation due to secondary apnea. The nurse auscultates to assess for endotracheal tube placement and notes breath sounds are louder on the right than the left. Which of the following is the next best step in management?

Question

The nurse is called to assist a 32-year-old G1P0 female who is in active labor with a viable intrauterine pregnancy at 30-weeks estimated gestational age.  The patient delivers a neonate who requires intubation due to secondary apnea. The nurse auscultates to assess for endotracheal tube placement and notes breath sounds are louder on the right than the left. Which of the following is the next best step in management?

Accepted Answer

Retract breathing tube slightly and reassess. A common complication of intubation is advancing the tube too far into the right mainstem bronchus.  This leads to louder breath sounds on the left than the right and can be remedied by retracting the breathing tube until bilateral breath sounds are heard. Although possible that the neonate has a pneumothorax on the left side, it is much less likely than an incorrectly positioned tube. Advancing the tube further is not an appropriate intervention because it would worsen the problem. Increasing the PEEP and PIP places the patient at risk for a pneumothorax and is not recommended in this situation.

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