Safety Precautions for Self-Performed Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Case of a Swallowed Swab

Abstract

Oropharyngeal and nasopharyngeal specimens collected by swabbing are the pillars of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics. Commercially available rapid antigen tests and self-sampling polymerase chain reaction services have made specimen collection available anytime and anywhere in nonmedical settings. In this study, we report the case of a 45-year-old man who accidentally ingested a swab during self-performed SARS-CoV-2 rapid antigen testing. Imaging studies revealed an elongated foreign body in the stomach. Urgent gastroscopy confirmed the presence of the swabbing applicator in the gastric lumen, which was retrieved using a loop without any complications. Millions of SARS-CoV-2 tests are performed daily, of which an increasing proportion are performed by laypeople. Foreign bodies account for a particular set of complications, which can be avoided by cautious sampling and using the correct technique. Radiopaque labeling of instruments would be useful. Otherwise, rare serious events can occur that may require immediate medical interventions.

Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge

“…Finally, 27 articles were selected for review. 3 11 12 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 40 41 …”

“…All the researched complications due to nasopharyngeal COVID-19 testing were classified, and the related information is shown ( Table 1 ). Retained swabs 3 12 16 17 18 20 21 24 26 27 32 35 due to swab fracture during the examination and epistaxis 3 12 17 24 28 32 were the frequently reported complications. Cerebrospinal fluid (CSF) leakage 3 11 12 15 22 23 28 29 30 33 34 36 was a frequently documented serious adverse event requiring prompt attention and evaluation.…”

“…Retained swabs after nasopharyngeal COVID-19 testing have been frequently reported in the literature. 3 12 16 17 18 20 21 24 26 27 32 35 Swabs for COVID-19 examination are intrinsically vulnerable to accidental fragmentation due to an inherent breakpoint mechanism for effective transfer to the transport vial, especially in uncooperative or sedated patients. 12 Moreover, accidental hard contact with nasal anatomical structures, including septal spurs and inferior and middle turbinates, are other risk factors for swab fracture.…”

“…Many cases of the retained swab could be managed with nasal endoscopic removal 17 20 24 27 or sometimes retrieved with a bronchoscope. 21 In addition, the swab fragments could be found in the gastrointestinal (GI) tract such as the stomach 16 26 and duodenum, 18 35 which requires GI endoscopy for retrieval. In one case, a fractured swab was found in the upper part of the nose behind the underlying severe septal deviation and was extracted after mini-septoplasty and septal spur removal.…”

“…However, numerous complications, from minor to even fatal ones, have been repetitively reported in the media 13 14 and literatures 3 11 12 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 although complications required further medical evaluation were rarely happened ranging from 0.0012% 24 to 0.026%. 20 In addition, excessive quarantine burden and stressful condition of the COVID-19 pandemic 37 38 occasionally causes uncomfortable testing by the examiner who may not fully understand the nasopharyngeal anatomy or clinically cautious events related to nasopharyngeal swabs.…”