Poster-2: Shiv Shanker Tripathi
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Title: Fractured tracheostomy tube removal with rigid bronchoscope- A rare case report
Biography
Biography: Poster-2: Shiv Shanker Tripathi
Abstract
Introduction: Breakage and displacement of tracheostomy tube into the respiratory tract is a dangerous late complication after tracheostomy. We like to present a case of a patient with fractured tracheostomy tube with respiratory distress posted for bronchoscopic removal.
Case: The case study begins with a 42‑year‑old male patient was admitted to the emergency department with dyspnoea. He was a known case of airway stenosis and had a Fuller’s tube in situ. Fibrotic stenosis at the level of fifth and sixth tracheal ring with calcification was found. Vitals were stable but saturation was low. On inspection of the tube, the inner part was missing and outer part was intact. Radiographs revealed the broken part of the tube in the right main bronchus. Removal was done using right bronchoscopy and patient was discharged with tracheostomy tube with adequate counselling regarding tube care.
Discussion: The Fuller’s tracheostomy tube usually gets fractured at the junction of flanges and the collar of the tube. Possible etiology includes prolonged use and seasonal cracking; repeated boiling and mechanical stress; erosion caused by tracheobronchial secretions; and manufacturing defects. The right main bronchus is the most frequent site of lodgement of the fractured segment. The fracture of the tube is common at the junction of the collar with the neck plates because stagnation of secretions is more in this area and these two parts are welded together. Anaesthetic management during the removal of fractured tracheostomy tube is challenging. Most of these patients will be having a compromised airway anatomy because of the primary disease process and fracture, and dislodgment of the tube may lead to life‑threatening airway obstruction.
Conclusion: Fracture and displacement of the tracheostomy should always be considered as a differential diagnosis in the event of a sudden onset respiratory distress in a patient with tracheostomy of long duration.