Inadvertent migration of guidewire into Murphy's eye of endo
Percutaneous dilatational tracheostomy (PDT) is one of the favored procedures for elective tracheostomy in Intensive Care Units. Complications happen when surrounding structures are traumatized. We report a case of percutaneous tracheostomy without assistance of a bronchoscope in which the J-tipped guidewire entered into the endotracheal tube (ETT) through the Murphy's eye and caused difficulty in railroading tracheostomy tube. A similar incident has been reported where the guidewire migrating into Murphy's eye did not allow dilatation.[1] We encountered a scenario wherein the guidewire migrating into the ETT allowed dilatation but did not allow subsequent railroading of the tracheostomy tube.
Case Report
A 22-year-old, mentally challenged young male operated for exploratory laparotomy, was scheduled electively for percutaneous tracheostomy to facilitate weaning from positive pressure ventilation and sedation after failed trial of weaning.
Percutaneous tracheostomy was performed at the bedside under standard monitoring care. Informed consent was taken. Supplemental sedation and analgesia were given along with 100% oxygen through the ventilator. The patient was positioned supine with a pillow under the shoulders to extend the neck. The anatomical landmarks were identified and marked. A dose of 10 mg of morphine with graded dose of intravenous propofol was administered. Direct laryngoscopy was performed, supraglottic suctioning was done, and the ETT was withdrawn to the laryngeal inlet after deflating the cuff partially....