Snapping of cook exchange catheter with subsequent dislodgement in a double-lumen endotracheal tube.

摘要

Exchange catheters are often used to assist in the changing of tracheal tubes. The following case illustrates one complication of using such exchange catheters. A 73-year-old man, admitted for pneumonia and requiring tracheal intubation for respiratory failure, was transferred directly from the intensive care unit to the operating room to undergo video-assisted thorocoscopy. An 8.0 single-lumen tracheal tube was in place. After inducing anesthesia with sev-oflurane, a Cook exchange catheter (Cook C-CAE-11.0-100-DLT-EF Extra Firm Exchange Obturator with Rapi Fit Adapters for Double-Lumen Endotracheal Tube, Cook Critical Care, Bloomington, IN) was placed through the 8.0 tracheal tube to the 30-cm mark. The tube was withdrawn, and the exchange catheter threaded through the blue bronchial lumen of a 41F Sheridan double-lumen endotracheal tube. The double-lumen endotracheal tube was met with mild resistance at 20 cm and then inserted to 29 cm at the patient's lips. Severe resistance was met when attempting to pull the Cook exchange catheter out of the double-lumen endotracheal tube and the exchange catheter stretched and then snapped. The broken end of the exchange catheter was 2 cm into the double-lumen tube and could not be reached with a hemostat.