Misconnection of Oxygen Tubing to the "Smart Cuff Manager" Causing Cuff Explosion: A Preventable Equipment Error
Alexander Tzabazis1, Christoph Niemeyer2, Markus Stuhr1
1From the Department of Anesthesia, Intensive Care, Rescue and Pain Medicine, BG Klinikum Hamburg, Hamburg, Germany.
Abstract:
We report a case of sudden airway bleeding and airway loss secondary to an accidental misconnection of oxygen tubing to a "Smart Cuff Manager" (TRACOE, TRACOE medical GmbH) instead of a "Humidotrach" (heat and moisture exchange (HME) filter; Humidotrach Pro Iso, Fahl Medizintechnik-Vertrieb GmbH).
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