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    Abstract
   Introduction
   Case Report
   Discussion
    References
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Table of Contents
INTERESTING IMAGE  
Year : 2017  |  Volume : 20  |  Issue : 1  |  Page : 100-101
Misdirected minitracheostomy tube


1 Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurgaon, Haryana, India
2 Department of Critical Care and Anesthesiology. Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurgaon, Haryana, India

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Date of Web Publication6-Jan-2017
 

   Abstract 

We report a patient who after an uneventful coronary artery bypass graft surgery and left ventricular aneurysmorrhaphy developed intracerebral hemorrhage and subsequently required minitracheostomy. Chest X-ray showed misdirected minitracheostomy tube facing upward toward the laryngeal opening which was repositioned using bronchoscope.

Keywords: Coronary artery bypass graft surgery, minitracheostomy tube, misdirection

How to cite this article:
Singh A, Nanda C, Mehta Y. Misdirected minitracheostomy tube. Ann Card Anaesth 2017;20:100-1

How to cite this URL:
Singh A, Nanda C, Mehta Y. Misdirected minitracheostomy tube. Ann Card Anaesth [serial online] 2017 [cited 2019 Nov 22];20:100-1. Available from: http://www.annals.in/text.asp?2017/20/1/100/197845



   Introduction Top


Tracheostomy is one of the most frequently performed surgical procedures on critically ill patients requiring prolonged mechanical ventilation in the intensive care unit. In the majority of cases, tracheostomy is performed as a temporary measure for patients requiring prolonged respiratory support and/or bronchial toilette. Tracheostomy tube placement can be performed via either a traditional open procedure or more commonly now by the percutaneous technique.


   Case Report Top


Minitracheostomy tube is commonly used for the removal of secretions in patients with excessive pulmonary secretions and poor cough efforts. [1] It can also be used for high-frequency jet ventilation in patients with acute airway obstruction or poor respiratory efforts. We describe an obese, male patient (body weight 86 kg, body mass index 33.5 kg/m 2 ) who after an uneventful triple-vessel coronary artery bypass graft surgery and left ventricular aneurysmorrhaphy developed intracerebral hemorrhage and subsequently required minitracheostomy due to obtunded consciousness level, poor cough efforts, and retained tracheobronchial secretions. A percutaneous, flanged, reclosable 4 mm internal diameter tube [Mini-Trach II, Portex, Smiths Medical International Ltd., Hythe, Kent, UK, [Figure 1] was inserted smoothly through the cricothyroid membrane, using Seldinger technique after aspiration of air from the trachea by an experienced operator. Immediate chest X-ray revealed misdirected tube, facing upward toward the laryngeal opening [Figure 2]a. The tube was repositioned using bronchoscope [Figure 2]b and no further untoward event happened.
Figure 1: Portex Mini - Trach II Seldinger Kit

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Figure 2: Chest X - ray showing misdirected minitracheostomy tube facing upward (arrows) (a), and normal position (arrows) of the minitracheostomy tube (b)

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   Discussion Top


Misplacement of minitracheostomy tube has been described in pleura, paratracheal space, subcutaneous tissues, oropharynx, esophagus, mediastinum, or blood vessels resulting in pneumothorax, subcutaneous emphysema, vocal cord injury, esophageal/mediastinal perforation, or bleeding complications. [2],[3] The case described underlines the importance of the fact that classical method of railroading a minitracheostomy tube over guidewire and introducer may sometimes result in misdirection. It may be advisable to perform direct laryngoscopy or bronchoscopy to ensure that retrograde passage of guidewire, introducer, and hence minitracheostomy tube has not occurred. Aspiration of air may not necessarily indicate correct placement of the minitracheostomy tube. In addition, direction of puncture needle may change during the procedure, resulting in malposition/misdirection of the guidewire. In patients with difficult anatomy (short, thick neck, tissue swelling, goiter, previous neck surgery), assistance of an ENT surgeon or a formal tracheostomy may be required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Lewis GA, Hopkinson RB, Matthews HR. Minitracheotomy. A report of its use in intensive therapy. Anaesthesia 1986;41:931-5.  Back to cited text no. 1
    
2.
Alexander R, Holland S, Taylor BL. Misplacement of a mini-tracheostomy. Anaesthesia 1995;50:1012.  Back to cited text no. 2
    
3.
Salah N, El Saigh I, Hayes N, McCaul C. Airway injury during emergency transcutaneous airway access: A comparison at cricothyroid and tracheal sites. Anesth Analg 2009;109:1901-7.  Back to cited text no. 3
    

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Correspondence Address:
Ajmer Singh
Institute of Critical Care and Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana - 122 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.197845

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    Figures

  [Figure 1], [Figure 2]



 

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