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About Failure of Endotracheal Tubes


Endotracheal Tubes are checked before intubation, but still device failures have been documented due to manufacturing defects, e.g. cuff valve failure. Other complications associated with the use of re-sterilized tubes, breakage of part of the tube or obliteration of the tube lumen by a foreign body, e.g. mucous plugs have also been documented.


Despite the check steps or visual inspection for physical defect, incidences of device failures are commonly encountered.


Laryngoscopy was done on a 1-month-old male infant and intubation was performed using a 3-mm id endotracheal tube (ETT) under vision. The child had no significant other medical complaints. On connecting the ETT to the circuit, the chest did not expand on ventilation, neither was there any air entry on auscultation. So, laryngoscopy was done and the position of the tube was assured; still the chest did not expand on ventilation. After this, the tube was taken out and without delay another tube of 3 mm id was connected. The baby was ventilated successfully, and on checking the previous tube, it was found that the T-connector of the ETT was obliterated. On inspection, it was found that this was a manufacturing defect as the tube was new. There were no complications due to this delay of intubation.


In this case, ETT had obliteration in the T-connector, which caused ventilation failure. This was a manufacturing defect as the tube was neither being reused nor was re-sterilized. Usually on inspection, the obvious defects of the tubes are discovered but the defects which are visually not very perceptible are missed. This incidence signifies the importance of reviewing equipment defects for internal auditing purpose, so that complications could be avoided, because negligence could cost a life.




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