Novel Method to Prevent the Inadvertent Retention of Throat Pack

Abstract

To the Editor A hazard of throat packs used during surgery in the mouth and pharynx is retention of the pack after tracheal extubation and subsequent total airway obstruction. Several methods to reduce the likelihood of throat pack retention have been described.1–6 Usually, the responsibility for removal of the pack rests with the person inserting it, unless of course a change of anesthesia personnel has occurred. Several remedies to the problem of the retained throat pack include allowing the end of the pack to hang outside of the mouth and also perhaps fastening it to the tracheal tube.2,3 However, the dangling end may result in instruments being caught in the pack,1 and attaching the pack to the tracheal tube makes intubation somewhat more difficult. Placing a suture through the pack has been suggested, but in craniofacial procedures, the suture may not be easily viewed.1 Finally, affixing a label to the patient or to the ventilator announcing the presence of the throat pack has been suggested, but may be difficult because of sterile preparation of the skin or movement of the patient to a different intensive care unit.4 The following describes our method that is simple to apply, adds no cost, and is free of limitations associated with previously described solutions to this problem. After placing the throat pack (usually a 150-cm length, 3-inch gauge) into the pharynx, the free end of the pack protruding from the mouth is tied around the end of the tracheal tube. In addition, a label identifying the pack as a “throat pack in” is affixed to both the throat pack and tracheal tube (Fig. 1). Because both the tube and the throat pack are thus connected to the label, removing the tracheal tube at the end of the case eliminates the likelihood of a retained throat pack and need for laryngoscopy for removal of the throat pack.Figure 1: Showing free end of the throat pack fastened to the tracheal tube and a printed label stating “THROAT PACK IN” is secured with transparent tape to both the tracheal tube and the throat pack.Our suggested method is especially useful in circumstances in which tracheally intubated patients are transferred directly from the operating room to the intensive care unit. Sudhakar Kinthala, MD, FNCA Rajashekar Mudaraddi, MD Kimberly T. Johnny, MBBS Department of Anesthesiology and Surgical Intensive Care Queen Elizabeth Hospital St. Michael, Barbados [email protected]