1. AN UNUSUAL BRONCHIAL FOREIGN BODY - A SUCTION CATHETER TIP!
DP Anand, S Murdoch
Adult Intensive Care Unit, St James’s University Hospital, Leeds, UK
Case report
The authors report a case of severe bronchospasm secondary to a bronchial foreign body – the distal 10 cm of a closed-tube suction catheter. This was discovered and removed during flexible bronchoscopy, before a percutaneous tracheostomy was performed. This patient was intubated and ventilated for a Type II respiratory failure due to an infective exacerbation of chronic obstructive lung disease.
Discussion
The exact mechanism of the shearing off of the distal tip of the suction catheter is unclear; we put forward the following hypotheses:
Inadvertent cutting and aspiration of the suction catheter while cutting the ETT to a shorter length
A pre-existent defect or breach in the integrity of the suction catheter that could have broken off with routine suctioning
An unnoticed foreign body could be potentially life threatening. Based on this report and literature review of earlier cases, we make the following recommendations to help prevent and identify such complications in the future:
Nurses and doctors involved in the suctioning of the tracheobronchial tree using respiratory care equipment should meticulously examine them before and after use and document the same.
Making all the suction catheters radio-opaque.
Early bronchoscopy for persistent bronchospasm not resolving with standard bronchodilators, to rule out foreign body aspiration.
References
Hari CK, Petheram T, Garth R: Unusual complication of reusable suction catheter during rigid bronchoscopy. Eur Arch Otorhinolaryngol 264(12): , 2007.
Garcia-Aparicio L, Castanon M, Tarrado X, Rodriguez L, Iriondo M, Morales L: Bronchial complication of a closed-tube endotracheal suction catheter. J Pediatr Surg 37: , 2002.
Meneghetti S, Trevisanuto D Cantarutti F, Zanardo V: Tracheal tube obstruction by suction catheter fragment in a premature baby with RDS. Paediatr Anaesth 6: , 1996.

2. An unusual bronchial foreign body – a suction catheter tip!
DP Anand MBBS1, S Murdoch MBBS, FRCA ST3 Anaesthetics, Mid Yorkshire NHS Trust Consultant Anaesthetist, ICU, St James’s University Hospital, Leeds
Introduction
The right main bronchus is a common destination for many inhaled foreign bodies. However, in a critically ill patient with a secure airway, the chances of this should be negligible. There are a limited number of previous case reports [1,2,3] describing the broken parts of airway equipment lodged in the bronchi, in neonatal and paediatric patients. The authors report a case of severe bronchospasm secondary to a bronchial foreign body – the distal 10 cm of a closed-tube suction catheter. This was discovered and removed during flexible bronchoscopy, before a percutaneous tracheostomy was performed. This patient was intubated and ventilated for a Type II respiratory failure due to an infective exacerbation of chronic obstructive lung disease.
Case report
A 65-year-old male patient was admitted to our intensive care unit (ICU) with an infective exacerbation of chronic obstructive pulmonary disease (COPD).