Description of Event or Problem · 1
PATIENT WHO PRESENTS WITH A CHIEF COMPLAINT OF NASAL FOREIGN BODY. HE WAS ADMITTED TO THE TRAUMA BURN SERVICE ON SUMMER OF 2012 WITH 20% TOTAL BODY SURFACE AREA BURNS REQUIRING INTUBATION AND DHT (DOBHOFF TUBE) PLACEMENT WITH BRIDLING. HE WAS UNEVENTFULLY EXTUBATED AND HIS DHT WAS DISCONTINUED DURING HIS STAY. DESPITE THIS HE STILL HAD A SENSATION OF A NASAL FOREIGN BODY. HE WAS DISCHARGED HOME APPROXIMATELY 24 DAYS LATER. HE VISITED HIS PCP AND RECENTLY AND WAS REFERRED TO THE OTO CLINIC WHERE HE WAS SEEN BY A NURSE PRACTITIONER. PER THE PATIENT HE WAS SCOPED, BUT THE NP DID NOT FEEL COMFORTABLE REMOVING WHAT APPEARED TO BE A METAL FOREIGN OBJECT AND WAS REFERRED. HE WAS SEEN BY THE TRAUMA BURN SERVICE IN CLINIC WHERE A SMALL METAL GUIDEWIRE WAS VISUALIZED IN THE LEFT NARES. REMOVAL WAS ATTEMPTED, BUT WAS ULTIMATELY UNSUCCESSFUL. HE PRESENTS TO CLINIC WITH THIN METAL WIRE PROTRUDING ABOUT 2 INCHES FROM HIS RIGHT NARES. HE NOTES 9/10 PAIN AND ODYNOPHAGIA, BUT NO ADDITIONAL SYMPTOMS. THE PLASTIC TIP OF THE GUIDE WIRE IS SMALLER THAN MANY PATIENTS NARES. IF THE GUIDE WIRE IS NOT REMOVED FROM THE WHITE BRIDLE CATHETER, THE PLASTIC TIP WOULD BE LODGED IN THE NARIS AND AS THE BRIDLE CATHETER IS PULLED AROUND THE VOMER BONE, THE GUIDE WIRE WOULD REMAIN IN THE PATIENTS NARIS.ORIENTATION TO THE APPLICATION OF THE DHT BRIDLE INCLUDES VIEWING THE VIDEO OF APPLICATION, OBSERVING THE PRECEPTOR APPLYING A DHT BRIDLE, AND APPLYING THE DHT BRIDLE UNDER THE OBSERVATION OF THE PRECEPTOR. THIS IS DOCUMENTED ON THE ORIENTATION SKILLS CHECKLIST.ROOT CAUSE ANALYSIS: THE SIZE OF THE PLASTIC TIP OF THE GUIDE WIRE ALLOWED FOR IT TO PASS THROUGH THE PATIENTS NARES.WHAT WAS THE ORIGINAL INTENDED PROCEDURE?BILATERAL ARM AND FACE BURNS REQUIRING INTUBATION AND DHT PLACEMENT WITH BRIDLING. ADDITIONAL INFO FROM REMOVAL PROCEDURE:RIGID NASAL ENDOSCOPY: AS A SEPARATE IDENTIFIABLE PROCEDURE RIGID FIBEROPTIC EXAMINATION OF NASAL CAVITY WAS PERFORMED. TOPICAL ANESTHETIC WITH 4% COCAINE WAS PLACED IN BOTH NARES. A 0 DEGREE RIGID ENDOSCOPE WAS FIRST PLACED IN THE LEFT NARES WHICH REVEALED A METALLIC FOREIGN OBJECT ALONG THE LATERAL FLOOR OF THE NOSE CURVING AROUND THE POSTERIOR CHOANA. THE SCOPE WAS THEN REMOVED AND PLACED INTO THE RIGHT NARES. A ORANGE CAP ON THE TIP OF THE GUIDEWIRE IS VISUALIZED POSTERIORLY WHICH APPEARS TO BE HOOKED ON THE SEPTUM WITH A DHT BRIDLE GUIDEWIRE ATTACHED. TAKAHASHI FORCEPS WERE THEN USED TO DISPLACE THE ORANGE CAP POSTERIORLY AND THE GUIDEWIRE WAS EASILY REMOVED FROM THE LEFT NARES ANTERIORLY. THE PATIENT TOLERATED THE PROCEDURE WELL WITHOUT ANY COMPLICATION.DEVICE #1:IS THIS A LABORATORY DEVICE OR LABORATORY TEST?NO.