Acute airway obstruction by a sheared endotracheal intubation stylet sheath in a premature infant

Chiou, Hung-Jr; Diaz, Rodney C.; Orlino, E.; Poulain, Francis R

doi:10.1038/sj.jp.7211829

Cited by 28 publications

(18 citation statements)

References 12 publications

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“…Literature reviews reveal that the majority of foreign bodies were derived from medical devices, reported objects included laryngoscope bulb [1], sheared stylet sheath [2,4], nasal prong [3], silicone suction catheter [5]. There were only 7 cases of neonatal gastrointestinal foreign bodies reported worldwide [1e5, 7,8].…”

Section: Discussionmentioning

confidence: 99%

An unexpected journey of a suction catheter in a preterm neonate

Leung

Chung

Wong

et al. 2015

Journal of Pediatric Surgery Case Reports

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a b s t r a c tForeign bodies are extremely rare in preterm neonates. The majority are iatrogenic. We describe a neonate of 27 weeks gestation who was found to have an 18 mm long suction catheter at the right main bronchi after resuscitation in another hospital. It was first detected by chest X-ray after endotracheal intubation. Repeat X-ray revealed the catheter moved to the stomach and migrated to the lower gastrointestinal tract in a few hours. The patient was treated conservatively and the catheter was passed out on day 14. Newborn resuscitation may result in iatrogenic foreign body in neonates. Serious complications such as respiratory compromise, perforations or abscess may occur. Early referral to a specialized tertiary center with pediatric surgical service is recommended. We hope our experience demonstrated the importance of preventing iatrogenic foreign body in clinical setting. Access to endoscopic instrumentation for foreign body removal in preterm neonates should be available at all times. Ó 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Foreign bodies are extremely rare in preterm neonates. The majority of the reported cases are iatrogenic and the foreign bodies were derived from medical devices [1e5]. Potential serious complications such as respiratory compromise, esophageal and gastrointestinal tract perforation may occur [6]. Prompt management to retrieve foreign body by endoscopic instrument or open method is required if there are signs of these complications. For small foreign body that is able to pass through the pylorus, it is possible to observe for spontaneous passage through anus. We describe an unusual journey of suction catheter that migrated from the right bronchus to the gastrointestinal tract and was eventually passed with meconium in a preterm neonate.A dichorionic diamniotic twin two was born by emergency cesarean section for placenta abruption at 27 weeks of gestation. He had a birth weight of 1.16 kg, Apgar score was 3 at 1 min and 1 at 5 min. He developed bradycardia at birth requiring endotracheal intubation and cardiopulmonary resuscitation for 1 min. Surfactant replacement was given because of severe respiratory distress syndrome of prematurity. A close circuit suction system (Kimvent 5Fr multi-access catheter, Kimberley-Clark, Atlanta, USA) was used while patient was receiving mechanical ventilation. He was extubated to non-invasive ventilation at 18 h of life. Chest X-ray at 21 h revealed an obliquely-oriented tubular opacity over medial aspect of right lower zone (Fig. 1).Computer tomography of thorax on day two of life showed an intraluminal elongated tubular foreign body measuring about 1.9 Â 1.9 mm across and 18.0 mm in length at right bronchus (Fig. 2). Collapse was noted at the right lower lobe superior segment. Consolidative changes were noted at the left upper lobe apicoposterior segment, left lower lobe anterobasal and laterobasal segments.The baby showed i...

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Section: Discussionmentioning

confidence: 99%

An unexpected journey of a suction catheter in a preterm neonate

Leung

Chung

Wong

et al. 2015

Journal of Pediatric Surgery Case Reports

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“…These stylets are often plastic coated to prevent airway injury from the metal end and to facilitate removal after insertion of the ETT. A review of the relevant literature in English yielded nine published reports related to the shearing of the plastic sheath covering intubation stylets in neonates between 1985 and 2016 [1][2][3][4][5][6][7][8][9]. Most cases reported either a partial or complete obstruction of ETT by the sheared portion of plastic coating.…”

Section: Discussionmentioning

confidence: 99%

“…Stylets are commonly used to facilitate endotracheal intubation of neonates in the delivery room, operating room, and neonatal intensive care unit (NICU). While several types of stylets are available for use, rare complications related to plastic-coated stylets or those covered by a plastic sheath have been reported [1][2][3][4][5][6][7][8][9]. In the majority of the documented cases, the endotracheal tube (ETT) was obstructed by the sheared-off portion of the stylet sheath.…”

Section: Introductionmentioning

confidence: 99%

Extremely Preterm Neonate with a Tracheobronchial Foreign Body: A Case Report

Viswanathan

Prado

Chua

et al. 2020

Cureus

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We report the case of an approximately 27-week gestational-age preterm infant admitted on the day of life number four for evaluation of a foreign body noted on serial chest X-rays. CT of the chest revealed a foreign body present in the trachea, extending from just above the tracheal bifurcation deep into the posterior basilar segment of the right lower lobe. Endoscopic removal of the foreign body revealed a portion of the plastic sheath of the stylet used during intubation. We also provide a brief review of the relevant literature.

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“…The foreign body was successfully removed using a rigid bronchoscope. Other reported foreign bodies include shearing of plastic sheath of the endotracheal stylet and rupture of closed endotracheal suction catheters [12,13].…”

Section: Case Of Endotracheal Suction Catheter As a Foreign Body In Amentioning

confidence: 99%