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Front-of-neck access and bougie trapping

Last post 11 Nov 2018, 5:43 PM by Naveeta Maini. 0 replies.
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  •  11 Nov 2018, 5:43 PM 2685

    Front-of-neck access and bougie trapping

    Sorbello et al. described “bougie-trapping” during front-of-neck access (FONA) simulation training, with lacerations occurring on the bougie surface due to difficulties encountered during bougie passage [1]. The resultant flap of material caused difficultly during bougie removal, with the endotracheal tube impinging on the flap. They recommend checking bougie integrity following such procedures.

    We recognise that this as a potential risk and presume such lacerations to the bougie are made more likely with any retrograde movement of the bougie whilst in close contact with the caudal facing scalpel blade. This would explain the directional nature of the laceration shown in their accompanying photographs and explain the resulting impingement on the endotracheal tube during bougie removal.

    We believe that anaesthetists should make every attempt to avoid retrograde bougie movement whilst the caudal facing scalpel blade is in situ, or if needed apply further lateral traction to create more space for safe bougie insertion. The danger still exists that if true impingement occurs and the bougie cannot be removed that the practitioner may need to remove everything from the airway. We believe that during such an event, one must keep something in the trachea at all times to maintain the tract, or perhaps put further lateral traction on the scalpel to allow for safe removal of the bougie and endotracheal tube.

     

    N. Maini

    S. Crawley

    Ninewells Hospital and Medical School,

    Dundee, UK

    Email:naveeta.maini@nhs.net

     

    No external funding or conflicts of interest declared.

     

    References

    1. Sorbello M, Godoroja D, Margarson M. Front-of-neck access and bougie trapping. Anaesthesia 2018; 73: 1173-4.
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