Featherstone and colleagues  recently described a critical incident that resulted from a Luer lock connector entering the bronchus of a patient during the management of bronchospasm using improvised apparatus. Whilst this method of inserting a metered dose inhaler (MDI) into a syringe is well recognised , the authors state that, “no proprietary adaptor exists” to allow the administration of an MDI in this situation. A number of devices are in fact commercially available for just such a purpose. We routinely use a 22mm male – 22mm female connector with an MDI insert (Intersurgical Ltd, UK) on our intensive care unit to administer aerosolised MDI drugs in preference to nebulised formulations (figure 1). It has been shown that this mode of delivery is more effective providing that a proper technique is employed. Further advantages are that the device is inexpensive, intuitive to use and allows reliable drug dosing . The device is located in line with the ventilator circuit as close to the patient as possible and the MDI aerosol delivered in synchrony with inspiration. The syringe method used in this case, in common with other improvised emergency equipment such as needle cricothyroidotomy apparatus , is likely to be ineffective and may compromise patient safety . It does not allow synchronised administration of the MDI with the inspiratory cycle, necessary for effective drug delivery.
We suggest that in order to provide safe, rapid and clinically effective care in emergency situations a device dedicated to MDI delivery should be available in all areas that anaesthesia is to be administered.
University Hospital of Wales, Cardiff
No external funding and no competing interests declared.
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