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Single‐use tracheal introducers may not be fit for purpose

2007; Wiley; Volume: 62; Issue: 11 Linguagem: Inglês

10.1111/j.1365-2044.2007.05334.x

1365-2044

I. Hodzovic, I. P. Latto,

Anesthesia and Sedative Agents

We read with interest the study by Rowley and Dingwall [1] on the use of single-use devices in anaesthesia. They stated that the responders to their interviews criticised the use of single-use devices, expressing their concerns about potentially fatal outcomes due to the compromised quality and efficacy of single-use equipment. The strongest criticism reported related to single-use tracheal tube introducers. We would like to add to the concerns that were raised by the clinicians who took part in their study. We conducted a national survey of introducer availability in 2005, three years after the Association of Anaesthetists of Great Britain and Ireland recommended the use of single-use intubation aids [2]. A postal questionnaire was sent to the College Tutors of all 306 anaesthetic departments in the UK. Information was sought on the availability of three tracheal tube introducers (Eschmann multiple-use and the Portex and Frova single-use introducers) and on any cases of airway trauma associated with the use of these introducers. Replies were received from 190 of the 306 College Tutors in the UK, giving a 62% response rate. The Eschmann multiple-use, Portex and Frova single-use introducers were available in 131 (69%), 97 (51%) and 73 (38%) of departments, respectively. Fifty-nine (31%) departments had single-use devices available only, 86 (45%) had single-use introducers available in conjunction with the Eschmann multiple-use introducer and 45 (24%) had only the Eschmann multiple-use introducer available. Serious airway trauma associated with the use of introducers was reported in 20 responses. Twelve of the 20 reports came from departments where only single-use devices were available. In nine of the 12, either ICU admission (seven incidents) or fatalities (two incidents) occurred. The original Portex single-use introducer (Portex Tracheal Tube Introducer, Smiths Medical International, Hythe, UK) became available in 1997. The Frova Intubating Introducer (Cook UK Ltd, Letchworth, UK) entered clinical practice in 1998. There is both in-vivo and in-vitro evidence [3–5] that the original 1997 Portex single-use introducer is less effective than the Eschmann multiple-use introducer. The success rate for tracheal placement with the Frova single-use introducer, on the other hand, is similar to the that with the Eschmann multiple use introducer [4]. However, serious concerns were raised regarding the potential for airway trauma when the Frova or Portex single-use introducers were used [4]. We could find no reports of airway trauma associated with the use of the currently available single-use tracheal introducers. Our survey suggests that anaesthetists seem unaware of the published differences in the performance of these introducers and that it is probable that airway trauma associated with the use of tracheal introducers is under-reported. Since 2005, manufacturers such as Proact (Proact Medical Ltd, Northampton, UK) and Intavent (Intavent Orthofix, Maidenhead, UK) have introduced slightly modified single-use tracheal tube introducers into clinical practice. Smiths Medical introduced a new version of the Portex single-use introducer in 2006. There is no evidence about either the comparative performances or the potential for airway trauma of these introducers. Anaesthetists involved in ordering equipment in the UK may be influenced by cost rather than performance. Clinicians may be forced to use whatever is handed to them by an assistant, with potentially serious consequences. Airway trauma is a cause for major concern and should be minimised by the use of optimal equipment. We fully endorse Rowley and Dingwall's conclusion that ‘the clinicians should be aware that patient safety is not threatened solely by the risk of contamination, and they should always question whether the devices they use are fit for purpose’. We recommend that both the Eschmann multiple-use introducer and a selected single-use introducer should be available in all departments until the most appropriate single-use device has been identified in respect of both successful placement and airway trauma.