Members of the medical team that extracted the 10-cm long broken cotton bud stick from the windpipe of the octogenarian Emirati woman.

Mariecar Jara-Puyod, Senior Reporter

A tracheostomy tube, inserted into the neck of a person to help him breathe, must only be cleaned with a catheter to avoid life-threatening incidents, according to an otolaryngologist or an ear-nose-throat specialist.

Dr. Ayman Helal added that in cleaning, the tracheostomy tube must first be carefully dislodged from the patient and reinserted back once the instrument is sucked-free of secretions. Cleaning could be done either once or twice a month.

Helal’s advice came through on Wednesday morning after an octogenarian Emirati woman had been recently declared in stable condition as well as in “good health” after having undergone a delicate four-hour surgery at the Burjeel Royal Hospital in Al Ain, for the extraction of a 10-centimetre broken cotton bud stick from her right bronchus – the large airway leading to the trachaea or windpipe and to the right lung.

“When we realised that a cotton bud stick had gone inside the trachea, we panicked and were clueless. Seeing her gasping, we rushed her to the hospital. Dr. Ayman Helal and the medical team were very supportive. It was a tough moment for us but the medical team reassured us. We would like to thank Dr. Ayman and his team for saving her life,” a relative of the elderly woman told Gulf Today.

Helal’s notes disclosed the patient, bedridden for years and suffering from “weak respiratory muscles,” has been looked after by a medical team including a doctor and nurses. She underwent tracheostomy in 2017. Since then, aside from the tracheostomy tube, she has also been “aided” for her breathing by a Continuous Positive Airway Pressure (CPAP) machine.

“Compared to her age, her health before the incident (had been stable). But due to the (broken cotton bud stick), her condition became very bad. She was brought to the hospital one hour after the incident happened. We transferred her to the (operating room) for the (four-hour) procedure from the (emergency room). The endoscopy (insertion of a long thin tube to observe the insides of an organ) revealed the position of the cotton bud stick in her right bronchus which triggered bronchial secretions which filled the space around the lungs. There was mild bleeding in her lungs,” Helal said.

The broken cotton bud stick dropped into the 80-year-old’s right bronchus, and eventually got stuck in her windpipe, when her homecare assistant was using this to clean the still attached tracheostomy tube. The accident resulted in the patient’s inability to breathe and her oxygen saturation dwindling.

“The least acceptable oxygen saturation for any patient is over 90 per cent but for normal healthy persons, this must be 90 to 100 per cent. Good thing they did not delay in taking her to the hospital. If not, she could have suffered terribly from bronchial spasm, lung infection, and dyspnea (tightness of chest, feeling of suffocation and breathlessness),” Helal explained.

With this, Helal described the removal of the broken cotton bud stick from the patient’s windpipe as “very complicated and challenging.” He and his colleagues had to cautiously navigate through her fluctuating and diminishing oxygen saturation: “When we were trying to remove the foreign body, we had to detach the oxygen and CPAP machine also. We had to keep her condition stable. We could only use a flexible bronchoscope considering her condition and tracheostomy. We inserted the flexible bronchoscope through the tracheostomy tube and tried to take the (broken cotton bud stick) out. We were conscious of her oxygen saturation, providing her with the oxygen supply. We would only try removing the (broken cotton bud stick) when her oxygen saturation (was restored back to) normal. This approach continued for four hours.”

“Finally, we were able to take the (broken cotton bud stick) out without affecting her oxygen saturation. Her brain and other organs were not affected and after removing the broken cotton bud stick, her condition became stable,” said Helal.