BACKGROUND
Airway fire is a rare, but potentially fatal, complication of tracheostomy.1–3 Standard precautions to reduce the risk of fire aim to keep the three elements of the ‘fire triangle’ – fuel, oxygen and heat – separate. These include avoiding the use of diathermy once the trachea is open and avoiding the use of high inspired oxygen concentrations. However, there are situations where these two particular precautions are difficult to take; for example, in a patient who requires diathermy to arrest a post-tracheostomy haemorrhage and who has a high oxygen requirement, leading to a potentially explosive combination of diathermy and oxygen. We report a further precaution to reduce the risk of fire in this situation.
TECHNIQUE
The patient is intubated endotracheally and standard precautions to reduce the risk of fire are taken. Additionally, a nasogastric tube is passed into the upper trachea and carbon dioxide is passed through it into the upper trachea as shown in Figure 1. This produces a high concentration of carbon dioxide in the operative field and a high concentration of oxygen in the lungs, separated by the cuff of the endotracheal tube. The high carbon dioxide concentration in the operative field is confirmed by a probe placed at the entrance to the tracheostomy and allows the use of diathermy with a reduced risk of fire.
Figure 1.
The nasogastric tube in place, above the balloon of the endotracheal tube.
DISCUSSION
This precaution has been used to reduce the risk of fire in patients who require diathermy to arrest a post-tracheostomy haemorrhage and who have a high oxygen requirement.
References
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