860

Letters to the Editor

We are pleased to have this additional evidence that the sense of continuance of responsibility to the family who has lost a child by death is becoming more widespread. The plan by which those personnel who should be most concerned are included in the evaluation of the total situation and, I assume, decide which of them shall consult with the parents, has much to commend it. I would venture an additional suggestion: inclusion of the resident physician and medical student directly involved in the care of the child. Direct participation in such an activity must be considered as essential to the training program and hence to the learning expeiienee. Editor

Tracheal foreign, body acquired during suctioning To the Editor: Introduction of new, and modification of old, techniques, procedures, and equipment are frequently followed by reports of unanticipated complications. We would like to report a case of a foreign body in the trachea of an infant undergoing selective bronchial suctioning with a polyvinyl feeding tube. The manufacturer had recently changed the packaging of the tube to include a transparent outer sleeve around the tip of the tube (Fig. 1), and failure to recognize this alteration in the packaging led to this previously unreported complication. A two-month-old male infant had persistent atelectasis despite postural drainage and hourly endotracheal tube suctioning. Under fluoroscopic control, selective bronchial lavage was performed using a No. 5 Fr. feeding tube (Argyle, Sherwood Medical industries, St. Louis, Mo.) inserted through the endotracheal tube. Apparent endotracheal tube obstruction was encounPu the Departments of Pediatrics and RadiologY, Indiana University Medical Center, The James Whitcomb Riley Hospital for Children. Supported in part by The National Foundation March of Dimes Service Grant No. C-117.

Fig. 1. Feeding tube with sleeve as packaged by manufacturer,

The Journal of Pediatrics November 1976

Fig. 2. Sleeve in endotracheal tube. tered during attempts at suctioning; therefore the patient was extubated. A 7 cm long radiolucent sleeve was found protruding from the endotracheal tube (Fig. 2). The infant improved immediately after reintubation. This serious and potentially fatal complication resulted because of an unnoticed change in the manufacturer's packaging. The outer sleeve, which had been recently added by the manufacturer, was not noticed prior to the procedure. We wish to warn others of the presence of this outer sleeve and to emphasize the need for a mechanism for routine notification of medical personnel when any changes in manufacturing or packaging are made. Richard L. Schreiner, M.D, Wilbur L. Smith, M.D, Edwin L. Gresham, M.D. Departments of Pediatrics and Radiology Indiana University Medical Center The James Whitcomb Riley Hospital for Children 1100 14d Michigan St. Indianapolis, Ind. 46202

H. influenzae buccol cellulitis and otitis media To the Editor: I was surprised to read in the commentary by Drs. Nelson and Ginsburg ~that "otitis has not been mentioned in previous reports of Hemophilus influenzae buccal cellulitis..." because it is clearly stated by Feingold and Gellis~ in their review of 16 patients that "four had otitis media" (reference No. 5 of the commentary). This is admittedly a minor point. Obviously, the editorial by Drs. Nelson and Ginsburg is an important contribution because it firmly documents the relationship of buccal cellulitis with ipsilateral otitis media. In addition it establishes the etiology as due to H. influenzae, type b, an organism that is recovered infrequently from middle ear fluid (as emphasized by Drs. Nelson and Ginsburg). Ronald G. Strauss, M.D. Division of Hematology/ Oncology St. Jude Children "s Research Hospital Memphis, Tenn. 38101

Tracheal foreign body acquired during suctioning.

860 Letters to the Editor We are pleased to have this additional evidence that the sense of continuance of responsibility to the family who has lost...
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