Bedside ultrasonography in confirming and monitoring endotracheal tube placement: a narrative review and implications for nursing practice in Poland

Introduction. Effective and rapid confirmation of endotracheal tube (ETT) placement is vital for patient safety. Traditional methods such as capnography or chest auscultation have diagnostic limitations, especially in emergencies or at low pulmonary perfusion. The increasing use of point-of-care ultrasound (POCUS) offers opportunities to expand nursing competencies. Aim. This narrative review presents ultrasound techniques used to confirm and monitor ETT placement, compares their effectiveness with classical methods, and evaluates their potential implementation in nursing practice. Material and methods. The review followed the SANRA guidelines. Databases PubMed, Embase, and Scopus (1992–2025) were searched, yielding 52 eligible publications. The analysed studies included randomized trials, prospective and cross-sectional studies, case series, and systematic or narrative reviews. Studies in which ultrasound was used only as an adjunct to intubation were excluded. Results. Point-of-care ultrasound (POCUS) shows high accuracy in confirming ETT placement – many studies report sensitivity and specificity above 95%, with confirmation times of only a few seconds. Protocols such as TRUE and 5-AIR standardize the procedure and improve safety. Compared with capnography and auscultation, ultrasound is faster and less dependent on haemodynamics. Limitations include study heterogeneity, single-centre designs and risk of artefacts. Implementation in nursing practice requires structured training, immediate equipment access and clear team roles.