2001 OPEN FORUM Abstracts
Unforeseen Complication of Nasotracheal Suctioning, A Case Study
Christopher M. Cella, RRT, Adult Clinical Specialist, Joshua O. Benditt, MD, University of Washington Medical Center, Seattle, Washington
Case Summary: A 79 year old male, five days status post coronary artery bypass grafts times 4 was an inpatient in our adult intensive care unit. The patient was receiving .50 oxygen via cool aerosol facemask, postural drainage and percussion every 4 hours, and nasotracheal suctioning every 4 hours and PRN as necessary. The patient had an ineffective spontaneous cough, and was unable to clear or expectorate secretions on his own. Chest x-ray revealed diffuse bilateral infiltrates.
Because the patient required suctioning on a regular basis, a #8 Roush nasal airway was maintained to help prevent nasal irritation and bleeding. Following a treatment of postural drainage and percussion, on ausculation the patient had coarse bilateral ronchi throughout his chest, he had a weak loose nonproductive spontaneous cough. It was deemed necessary to suction the patient. With the assistance of his RN, the patient was preoxygenated with 1.0 oxygen prior to the procedure. Using sterile technique, a 14 french Allegiance suction catheter was advanced into his oropharynx, and vacuum applied. Approximately 15 ml. of tenacious beige secretions were aspirated. After 30 seconds, the catheter was advanced during inspiration in attempts to remove secretions from is trachea. Vacuum was applied, but no secretions were aspirated. The catheter was advanced and retracted several times in effort to enter the trachea. Vacuum was applied and again, no secretions were aspirated. At this time catheter was withdrawn from the airway. As it was retracted, the nasal airway became dislodged and was removed from his nare simultaneously. Much to our surprise, the end of the catheter had been tied into a knot! We suspect that the patient used his tongue to twist the catheter into this configuration.
Discussion: Hazards and complications of NT suctioning from the AARC Clinical Practice guidelines include laceration of nasal turbinates, perforation of the pharynx, nasal irritation/bleeding, tracheitis, and mucosal hemorrhage. In this unusual case it was most likely beneficial that the nasal airway was in place, as it cleared the way as the knotted end of the catheter was removed from his airway. Clinicians need to e aware of this potential complication when performing this procedure