Fractured closed suction catheter: an unusual cause of endobronchial obstruction in a ventilated patient

Background

: A 32-year-old HIV-positive man required ventilation for seizures secondary to viral encephalitis. He had a prolonged care unit stay and had percutaneous tracheostomy performed on day 14 of his admission. He subsequently developed persistent right basal infiltrates and atelectasis on chest radiographs that were slow to respond to antibiotic treatment. Fiberoptic bronchoscopy revealed the cause of his infiltrates to be a 14-cm tip section of closed suction catheter tubing that had presumably fractured during suctioning and became lodged in his trachea and right main bronchus.

Learning point

: Foreign body aspiration should be considered in the differential diagnosis of persisting lung infiltrates or atelectasis in all patients.

Conclusion

: This case describes a rare cause of endobronchial obstruction in a ventilated patient. Medical staff requires education about the importance of ensuring that suction catheters and other airway adjuncts are intact following use to prevent possible airway foreign bodies.