Retrieval of Aspirated Nasopharyngeal Airway Using Foley Catheter

Abstract

To the Editor: A nasopharyngeal airway (NPA) is a simple airway adjunct used to maintain a patent airway and to facilitate nasotracheal suctioning.1 We report a sudden airway obstruction caused by a nasal airway that slipped into the trachea and its retrieval. An 83-year-old man presenting with a stroke and a Glasgow coma score of 12 responded to verbal commands but had snoring with partial airway obstruction. A size 7.5 NPA was inserted via the right naris and successfully relieved the airway obstruction. Thirty hours later, the SpO2 decreased to 91% to 92%, and the patient had repeated bouts of forceful coughing. On attempting to suction via the NPA, it was found to be missing. After mask ventilation with 100% oxygen, 60 mg propofol was administered, the oropharynx and hypopharynx were sprayed with 10% lidocaine, and direct laryngoscopy revealed the tip of the NPA to be protruding through the cricoid with its flange barely visible. Two attempts to retrieve the NPA using Magill forceps failed. A well-lubricated sterile Foley catheter (14F, Rusch, Teleflex Medical GmbH, Kemen, Germany) was passed into the lumen and beyond the tip of the NPA and its balloon inflated with 6 to 7 mL air. Thereafter, gentle traction on the Foley catheter led to retrieval of the NPA and relief of the airway obstruction. Aspiration of an NPA has been reported and can be life threatening.2,3 To prevent this, either a safety pin inserted through the flange of the NPA or a 15-mm tracheal tube connector/adaptor inserted into the proximal end of the NPA has been recommended.4,5 In our case, a tracheal tube connector was used but became loose and was dislodged allowing aspiration of the NPA to occur. If we had failed in our attempt to retrieve the NPA, we would have continued with mask ventilation with 100% oxygen and asked an ear-nose-throat surgeon to remove the NPA using a rigid bronchoscope and forceps. Rajesh Mahajan, MBBS, MD Rishab Bassi, MBBS, MD Department of Anesthesia ASCOMS Medical College Jammu and Kashmir India [email protected] Shivani Mehta, MBBS, MD Department of Pathology Government Medical College Jammu and Kashmir India