Ventilation failure due to endotracheal tube T-connector defect

Shamshery, Chetna; Kannaujia, Ashish

doi:10.4103/0019-5049.68382

Cited by 8 publications

(14 citation statements)

References 4 publications

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“…If there is no problem in the system, the ET tube should be checked. Herniation of the ET cuff, kinking of the tube, intraluminal plastic film or obstruction by meniscus and obliteration of the ETT connector are the known manufacturing defects that can result in difficulty in ventilation [1,3,[6][7][8][9]. In case 1, there was a narrowing of the tube connector making ventilation difficult.…”

Section: Discussionmentioning

confidence: 99%

“…In preoperative preparation period, ET tube, particulary its cuff and lumen, should be checked. If manufacturing defect is not noticed in preoperative period, it can result in serious airway obstructions [1,3,[6][7][8][9] or air leakage during anesthesia [10][11][12]. If manufacturing defect of ET tube is suspected, then the equipment must be immediately changed.…”

Section: Discussionmentioning

confidence: 99%

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Two different endotracheal tube manufacturing defects

Özer¹,

Erhan²

2013

IJCRI

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Introduction: Although manufacturing defects related to airway equipment are not so common in practice, it risks the safety of the airway. Prompt recognition of equipment malfunction can prevent life threatening complications. Case Series: Case 1: A 25yearold patient had anesthesia induction for septorhinoplasty surgery. After the patient was ventilated via mask and intubated without problem, peak and plateau pressures increased above 35 cm H 2 O on controlled ventilation. It was noticed that the anesthetic reservoir bag did not maintain adequate compliance in a setting of high peak and plateau pressure and was thought to be due to a faulty endotracheat tube (ETT) connecter. We noticed that lumen of ET tube connector was narrow and connecter has been changed. After this change the relaxation of the balloon and a decrease in the ventilator pressures were noted. Case 2: A 45yearold female patient had anesthesia induction for hysterectomy. After induction it was noted that there was a leak in the circuit, which was traced to the connection between the ETT and the inflation tube. An opening at the point of the connection of the EET with the inflation tube was detected. ETT

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Two different endotracheal tube manufacturing defects

Özer¹,

Erhan²

2013

IJCRI

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“…Device and circuit failures have been reported in literature and had lead to severe complications. Improper connection of Bain's circuit 1 , inopportune breakage of an endotracheal tube T-connector 2 , breakage of inner coating of resterlised tube 3 , obliteration of the tube lumen by manufacturing defect 4 or a foreign body, e.g. mucous plug or chewing gum 5 have been noted.…”

Section: Sirmentioning

confidence: 99%

Ventilatory failure due to improper capnography connector

Prakash

Kushwaha

Singh

2014

Int J of Biomed & Adv Res

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Sir,Device failure and improper connections can lead to significant complications in anaesthesia practice. We describe here an incidence of ventilatory failure due to improper fitting of connections. A 25 yrs. old female was posted for laparoscopic cholecystectomy under GA. Apart from chronic cholecystitis, she did not had any other disease or comorbid condition. Inside OT, monitors were connected and she was preoxygenated with Bain's circuit. Induction was done with propofol and after ensuring proper mask ventilation vecuronium was given. After 5 minutes, an endotracheal tube (ETT) of 7.5 mm ID was placed in trachea with direct laryngoscopy under vision. After placement of ETT, capnography sampling line was connected to Bain's circuit and ETT using an angle connector and patient was ventilated. A strong resistance was encountered during ventilation and capnography showed small and narrow curve suggestive of obstruction. Inadequate chest rise was seen during ventilation. Chest ausculatation was done and bilateral decreased breath sounds was found. No added sounds like rhonchi or crepts was present.We rechecked the position of ETT with laryngoscopy and checked Bain's circuit for kinking or damage. We tried to ventilate the patient with AMBU bag and did not found any resistance during ventilation. Adequate chest rise with good bilateral breath sounds was found. We rechecked the Bain's circuit and found that the angle connector of capnography sampling line was loosely fitting in bain's circuit and on pushing hard, it was obstructing the outer tubing of Bain's circuit. This was causing resistance in ventilation and inadequate chest rise. We changed the angle connector and again tried to ventilate the patient with same Bain's circuit and found no resistance this time. There was no complication due to this defective connection and further surgery was uneventfull.Anaesthesia machine, ETT and bain's circuit were checked before induction and they were found normal. This problem aroused due to improper fitting of connections caused by wear and tear of angle connector of capnography sampling line after multiple use. Device and circuit failures have been reported in literature and had lead to severe complications. Improper connection of Bain's circuit 1 , inopportune breakage of an endotracheal tube T-connector 2 , breakage of inner coating of resterlised tube 3 , obliteration of the tube lumen by manufacturing defect 4 or a foreign body, e.g. mucous plug or chewing gum 5 have been noted. This Bain's circuit was neither being reused nor was resterilised. Usually on inspection, the defects of the tubes and circuit can be discovered but the defects which are visually not very perceptible may go unnoticed. This incidence signifies the importance of systemic checking of equipment defects, so that complications can be avoided, because negligence can pose significant risk to life of the patient. AbstractVentilatory failure due to improper or loose breathing circuit connection can occur in anaesthetic practice and may lead to sig...

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“…There are many reports in literature where manufacturing defects involving the cuff inflation system or patency of connectors have been described. [ 2 3 4 5 ] All these reports emphasize on pre-use check for cuff leak and tube patency. The routine check of airway connectors for circuit compatibility has not been recommended as their size has been standardized (15 mm diameter) so that all airway devices are readily connectable to anesthesia circuit.…”

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confidence: 99%