Cutting tracheal tubes in situ

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We routinely perform bronchoscopy following percutaneous tracheostomy to check if the carina is visible and to aspirate blood and secretions. During a recent case, we found a section of plastic tubing lodged in a patient’s right main bronchus following tracheostomy. We initially suspected that it had originated from the tracheal dilator, as we were using new equipment with which we had less experience. Upon retrieval, we discovered that it was the end of a suction catheter from a closed suction device (Kimberly-Clark Ltd, West Malling, Kent, UK, Fig. 3). Close inspection revealed that it had been cut cleanly, as if with a pair of scissors.

Figure 3.

 Photograph of the 7-cm section of suction catheter retrieved from the patient’s lung next to a complete device along with its angle piece connection. With the tip protruding in this manner, there is a risk of it being severed when the tracheal tube is cut.

Further enquiry revealed that the previous tracheal tube had been cut in situ because the suction catheter would not pass easily along that. We concluded that the suction catheter had not been pulled back fully and that the end had been accidentally severed as it still lay inside the tracheal tube when the latter was cut. Retrospective inspection of chest radiographs showed no signs of a foreign body.

Cutting tracheal tubes in situ is hazardous, as it may prove impossible to reinsert the tracheal tube connector into the new cut end of the tube. Our case provides a further reason to apply caution when performing this manoeuvre.

No external funding and no competing interests declared.

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