An Unusual Tracheobronchial Iatrogenic Foreign Body-Airway Exchange Catheter

罕見的醫源性氣管支氣管內異物：呼吸道交換導管

羅賢益(Hsien-Yi Lo)；張凱玲(Kai-Ling Chang)；謝榮元(Rong-Yuan Hsieh)；蔡宗龍(Tsung-Lung Tsai)；鐘威昇(Wei-Sheng Chung)

醫源性異物 ； 吸道交換導管 ； 氣管支氣管內 ； Iatrogenic foreign body ； Airway exchange catheter (AEC) ； Tracheobronchial tree (TBT)

醫學與健康期刊

5卷1期（2016 / 03 / 01）

125 - 129

英文

處理呼道的異物對臨床醫師是一項挑戰。文獻報告少見醫源性異物在氣管支氣管內。臨床醫師經常使用呼吸道交換導管當作指引來為長期氣管插管的病人替換氣管內管，但是呼吸道交換導管的材質可能老化造成斷裂。本文報導罕見個案，更替氣管內管時呼吸道交換導管斷裂並掉落在氣管支氣管內，經胸腔內科支氣管鏡辛苦取出。我們建議臨床醫師在使用呼吸道交換導管來替換氣管內管之前及之後應檢查交換導管的長度及脆性，以避免醫源性的疏失。

Treating foreign bodies in the airway is a challenging clinical problem for clinicians. Reports on iatrogenic foreign bodies in the tracheobronchial tree (TBT) are rare. The physicians usually use an airway exchange catheter (AEC) as a guidewire to replace the endotracheal tube for prolonged intubated patients who refuse tracheostomies. However, the aging of the catheter material may make it fragile and vulnerable. Herein, we report a rare case of a broken guidewire, AEC, in the TBT after replacement of the endotracheal tube. We recommend the physicians perform a check-up for length and fragility of the AEC before and after endotracheal tube replacement.

1. Bain, A,Barthos, A,Hoffstein, V,Batt, J(2013).Foreign-body aspiration in the adult: presentation and management.Can Respir J,20,e98-9.
2. Cheung, NH,Napolitano, LM(2014).Tracheostomy: epidemiology, indications, timing, technique, and outcomes.Respir Care,59,895-919.
3. Dikensoy, O,Usalan, C,Filiz, A(2002).Foreign body aspiration: clinical utility of flexible bronchoscopy.Postgrad Med J,78,399-403.
4. El-Orbany, M,Salem, MR(2013).Endotracheal tube cuff leaks: causes, consequences, and management.Anesth Analg,117,428-34.
5. Limper, AH,Prakash, UB(1990).Tracheobronchial foreign bodies in adults.Ann Intern Med,112,604-9.
6. Lin, L,Lv, L,Wang, Y,Zha, X,Tang, F,Liu, X(2014).The clinical features of foreign body aspiration into the lower airway in geriatric patients.Clin Interv Aging,9,1613-8.
7. Pinto, A,Scaglione, M,Pinto, F(2006).Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography.Radiol Med,111,497-506.
8. Qureshi, A,Behzadi, A(2008).Foreign-body aspiration in an adult.Can J Surg,51,E69-70.
9. Qureshi, AA,Lowe, DA,McKiernan, DC(2009).The origin of bronchial foreign bodies: a retrospective study and literature review.Eur Arch Otorhinolaryngol,266,1645-8.
10. Sengupta, S,Swaika, S,Banerjee, SS,Sheet, J,Mandal, A,Bisui, B(2014).Successful emergency airway management in a case of removal of foreign body bronchus in a pediatric patient.Anesth Essays Res,8,250-2.