Accidental fracture of the tip of the Coopdech bronchial blocker during insertion for one lung ventilation.

PURPOSE

The distal tip of a Coopdech bronchial blocker has a preformed angulation to aid placement in the desired bronchus. We report two cases wherein this design may have resulted in distal tip fracture due to entanglement at the level of the Murphy's eye of the endotracheal tube or at the carina.

CLINICAL FEATURES

A 49-yr-old female had a Coopdech bronchial blocker inserted into her right main bronchus for video-assisted thoracoscopic (VAT) lung biopsy. Resistance was encountered on its insertion, followed by confirmation of its position by fibreoptic bronchoscopy. As lung isolation was inadequate, bronchoscopy was repeated during surgery. This showed fracture of the blocker tip that required patient repositioning and insertion of another blocker. In a second incident, a bronchial blocker was inserted into the right main bronchus of a 19-yr-old male for VAT bullectomy. This procedure was performed under continuous fibreoptic guidance. Nevertheless, it was difficult to pass the blocker tip beyond the Murphy's eye of the endotracheal tube, as repeated attempts resulted in its entanglement and fracture. Another blocker was inserted by maneuvering the tip beyond the Murphy's eye.

CONCLUSION

The preformed tip of the Coopdech bronchial blocker can be damaged at the Murphy's eye of the endotracheal tube or at the carina. This can result in tip fracture, especially during insertion into the right main bronchus. Maneuvering the tip away from the Murphy's eye can circumvent this problem. Continuous bronchoscopic guidance should be used as recommended by the manufacturer.