Case 69: An ETT Suction Problem
A 5-week-old girl (4 kg) is admitted from a rural hospital via helicopter. She is diagnosed with a lower respiratory tract infection, which, after 2 days in the rural hospital, has now progressed to respiratory failure. You see the child immediately on arrival in the emergency room (ER). The child is struggling and the oxygen saturation has fallen to 84 % in the last few minutes. You quickly place an orally 3.5 endotracheal tube (ETT) and the vital signs improve dramatically. The ETT was cut by you prior to the insertion to get the correct length of the ETT. Prior to the ETT being placed in the trachea, the International Organization for Standardization (ISO) connector is attached to the ETT, however with some difficulty. (See Case 48 for a better way to put the ISO connector on the ETT after the tube has been cut). Two hours later, you get a call from the intensive care unit (ICU) telling you that it is not possible to pass any sized suction catheter down the ETT.