An Unusual Conduit for a Paediatric Tracheostomy Tube Exchange

This case report demonstrates the challenges of the paediatric airway, and useful, practical solutions in the management of tracheostomies in children. A six-year-old child underwent a tracheostomy, where an inappropriately large tracheostomy tube was inserted. The choice was guided by the internal diameter (ID) of the tracheostomy tube (TT) rather than the external diameter of the TT (which is much larger than the external diameter (ED) of an endotracheal tube (ETT)). The reduced diameter of the paediatric airway led to complications following the tracheostomy insertion. The TT needed to be exchanged to a smaller size to provide reliable access to the trachea. Access to the airway had to be maintained during the exchange process, as there was extensive head and neck swelling, which would have made re-intubation from above impossible. The conduit chosen for the tube exchange was a section of tubing from a high-capacity fluid administration set. Fixation of the tube was difficult, but finally achieved by a modified cable tie. Tracheostomy is a potentially hazardous procedure in children. The correct size TT needs to be selected with consideration of the ED rather than ID of the TT. This case report also demonstrates the utility of the tubing of a high-capacity fluid administration set for TT exchange and the use of a modified cable tie for fixation of the ETT.Keywords: Airway Management, Anaesthesia, Exchange Catheters, Paediatric Tracheostomy, Tracheostomy Tube Exchang