Bougie through Murphy’s Eye During Airway Exchange: A Near Miss

Abstract Endotracheal tube (ETT) exchange is a common procedure performed in the operating room and intensive care unit for the purpose of changing damaged or soiled ETT with appropriate one. The exchange procedure is performed over an airway exchange catheter or ETT introducer (bougie). We report an event during ETT exchange over bougie wherein the introducer exited through Murphy’s eye. Here, we intend to re-emphasize the safety concerns pertaining to the use of bougie (with coude tip) as airway exchange conduit and enumerate the precautions to be taken during tube exchange.

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Revisiting a case of difficult airway with a rigid laryngoscope

BMJ Case Reports ◽

10.1136/bcr-2018-224616 ◽

2019 ◽

Vol 12 (7) ◽

pp. e224616

Author(s):

Poonam Pai BH ◽

Ali N Shariat

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Distress ◽

Difficult Airway ◽

Endotracheal Tube ◽

Operating Room ◽

Intensive Care Unit Setting ◽

Airway Exchange Catheter ◽

Novel Technique ◽

Airway Exchange

A cook airway exchange catheter is a long hollow and semirigid catheter which is routinely used for endotracheal tube (ETT) exchange in the intensive care unit setting or even in the operating room in an event of unexpected difficult airway. We describe a novel technique of using an ETT exchanger with the help of a rigid laryngoscope to facilitate intubation as a strategy in a patient with an anticipated difficult airway due to laryngeal cancer presenting as stridor with respiratory distress.

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Oral to nasal endotracheal tube exchange using an airway exchange catheter in a neonate with Pierre Robin Sequence

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2014.09.013 ◽

2015 ◽

Vol 27 (1) ◽

pp. 80-81 ◽

Cited By ~ 1

Author(s):

Bridget L. Muldowney ◽

Elizabeth C. Eastburn ◽

Charles D. Nargozian

Keyword(s):

Endotracheal Tube ◽

Pierre Robin Sequence ◽

Airway Exchange Catheter ◽

Exchange Catheter ◽

Robin Sequence ◽

Tube Exchange ◽

Airway Exchange ◽

Pierre Robin

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Airway exchange catheter and laser endotracheal tube

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2004.12.011 ◽

2005 ◽

Vol 17 (4) ◽

pp. 324 ◽

Cited By ~ 1

Author(s):

Julio Cortinas ◽

Valentín Caruezo ◽

Cristina Penide ◽

Julián Alvarez

Keyword(s):

Endotracheal Tube ◽

Airway Exchange Catheter ◽

Exchange Catheter ◽

Airway Exchange

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Hypoxic Respiratory Failure Further Complicated During Airway Exchange Catheter Placement

The Journal of Critical Care Medicine ◽

10.2478/jccm-2020-0023 ◽

2020 ◽

Vol 6 (3) ◽

pp. 186-189

Author(s):

Osman Ali ◽

Avelino C. Verceles ◽

Matthew L. Barrett ◽

Christopher M. Franklin ◽

Imran Khan ◽

...

Keyword(s):

Case Report ◽

Endotracheal Tube ◽

Lung Compliance ◽

Jet Ventilation ◽

Lung Inflation ◽

Airway Exchange Catheter ◽

Exchange Catheter ◽

Frequent Use ◽

Hypoxic Respiratory Failure ◽

Airway Exchange

AbstractIntroductionAn airway exchange catheter is a hollow-lumen tube able to deliver oxygen and maintain access to a difficult endotracheal airway. This case report demonstrates an undocumented complication associated with an airway exchange catheter and jet ventilation, particularly in a patient with reduced airway diameter due to thick endotracheal secretions. Due to the frequent use of airway exchange catheters in the intensive care unit, this report highlights an adverse event of bilateral pneumothoraces that can be encountered by clinicians.Case PresentationThis case report describes a 24-year-old female with severe adult respiratory distress syndrome and thick endotra-cheal secretions whose hospital course was complicated by bilateral pneumothoraces resulting from the use of an airway exchange catheter connected to jet ventilation. During the exchange, the catheter occluded the narrowed endotracheal tube to create a one-way valve that led to excessive lung inflation.ConclusionAirway exchange catheters used with jet ventilation in a patient with a narrowed endotracheal tube and reduced lung compliance have the potential risk of causing a pneumothorax. Clinicians should avoid temporary concomitant oxygenation via jet ventilation in patients with these findings and reserve the use of airway exchange catheters for difficult airways.

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