The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

WIRE REINFORCED TRACHEOSTOMY TUBES MAY PRODUCE UNACCEPTABLE SCANNING INTERFERENCE DURING MAGNETIC RESONANCE IMAGING IN CHILDREN – REPORT OF A CASE

Darcy O’Brien-Genrich1, Edward Truemper2; 1Respiratory Care Services, The Nebraska Medical Center, Omaha, NE; 2Department of Pediatrics, Critical CareMedicine, The NebraskaMedical Center,Omaha, NE

Introduction: Our chronically ventilated pediatric population typically uses custom wire reinforced tracheostomy tubes (TT) manufactured by Bivona® to ensure proper fit and length. Some patients require magnetic resonance imaging (MRI) which precludes most metal containing medical devices because of magnetism and heat production. Changing to a standard length non-wired reinforced tube poses an increased risk such as tube dislodgement during the procedure because of limited monitoring options and line of sight. The Nebraska Medical Center contacted the manufacturer for safety information. According to Smith-Medical®, “When leaving a Bivona® wire reinforced TT in place during an MRI there will be no interference between the magnet and the metal/wire to cause heat damage to the patient or movement of the tracheostomy tube. However the wire may distort the image at the tracheostomy site.” Given this statement, the Respiratory Department was prepared to forgo tube changes prior to MRI scanning if image quality was not compromised. We report a case of a toddler who underwent an MRI of the chest with a Bivona® in place. Case Summary: A 22 month-old-female with a history of primary prematurity, multiple visceral organ transplants and tracheal tube dependency was admitted with severe pulmonary hemorrhage and hypoxic respiratory failure. An MRI of the chest was performed to investigate for a vascular source of the pulmonary bleeding. Because of the potential risks of tracheal tube dislodgment coupled with the need for positive pressure settings to prevent further hemorrhage, the Bivona® was left in place. The initial scans however, revealed considerable image disruption extending upwards to the base of the skull down to the upper abdomen. Image quality was too poor to allow for radiographic interpretation. The TT was changed to a non-reinforced tube and a repeat MRI scan resulted in acceptable images with no image distortion. Discussion: Although Bivona® TT are considered medically safe for MRI; the wire can result in distortion, significantly degrading image quality. Computed tomography should be considered as an imaging option or a non-wire reinforced TT should be substituted in the pediatric population when MRI scanning is required of the head, neck and chest. Changing from custom fit to standard length TT should necessitate increased visual surveillance and direct clinical assessment during the MRI procedure to avoid respiratory compromise. Sponsored Research - None

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