To the Editor:-A broken Y-connector and a brittle tube connector have been reported to cause a circuit leak with potential aspiration of the fragment. [1,2]We recently encountered a similar complication with the Univent[registered sign] endotracheal tube.
A 65-yr-old man underwent resection of the metastatic tumor of the right lung. A 9.0-mm ID Univent[registered sign] tube was used during the procedure. At the conclusion of the procedure, before awakening the patient, we pulled the tube connector out of the tube and reinserted it twice during the process of taking a chest radiograph. We subsequently performed a bronchoscopic examination and found something transparent in the trachea near the carina. We took it out and found its material and shape corresponded with a defect of the inner wall of the proximal end of the Univent[registered sign] tube (Figure 1).
In the Univent[registered sign] tube, the proximal portion of the lumen for the bronchial blocker is filled with the same material as the tube itself. However, the boundary between the tube and the filled material can be peeled off by strong force; we confirmed this possibility with another Univent[registered sign] tube. In addition, because the diameter of the enclosed connector is designed to be larger than the inner diameter of the tube, the connector tends to scrape the inner wall of the tube on insertion and is easily pulled out unless inserted very deeply. In this case, the repeated reinsertion of the connector into the tube tore off the inner wall, resulting in a foreign body in the trachea.
Although the Univent[registered sign] tube has been widely used for more than 10 yr, this complication has not been previously reported. The manufacturer is now planning to improve the shape and material of the tube or to enclose a warning in the package. Until this is done, we strongly recommend that the connector be pushed gently into the tube from the side of the blocker first to prevent scraping the fragile inner wall.
Tokuya Harioka, M.D.
Satoshi Hosoi, M.D.
Koichiro Nomura, M.D.
Department of Anesthesia; Shimada Municipal Hospital; Noda 1200-5; Shimada, Shizuoka 427, Japan;SGB01364@niftyserve.or.jp
(Accepted for publication April 7, 1998.)