An innovative way to reinsert dislodged Arndt blocker using urological glide wire

  • A 34-year-old  female patient with left upper lobe solitary lung nodule was planned for left thoracotomy and frozen section biopsy followed by laparoscopic cholecystectomy for cholelithiasis.

  • The left lung was isolated with a 7F Arndt BB introduced through a7.5 ETT and  lung collapse was achieved.

  • During one lung ventilation in the lateral decubitus position, the wire loop was removed for oxygen insufflation for treating hypoxia. There was dislodgement of the blocker which was confirmed by FOB.

  • A straight 0.032 inch zebra glide wire was introduced through the accessory port of the pediatric FOB. The proximal end of the glide wire was introduced into the distal central lumen of the Arndt BB, and the blocker was railroaded over it into the left main bronchus under fiberoptic  guidance and lung isolation was maintained throughout the procedure.

  • The Arndt blocker was removed along with the multiport connector at the end of the thoracotomy

Discussion

  • Even though BBs may take a slightly longer time for positioning, the deflation of the lung is comparable to that using a DLT

  • The incidence of mal-position of blockers is also more compared to DLT

  • All the Arndt blocker sizes have a wire loop that is used for introduction into the desired bronchus by coupling the blocker to an FOB

  • Once the nylon wire loop removed, it cannot be reinserted in 5F and 7F blockers

  • Reinserting the Arndt blocker, without the wire loop, into the left main bronchus or the nondependent lung in the lateral decubitus position, is a great challenge, often needing replacement with a new blocker

  • As BBs are expensive we chose a urological zebra glide wire as they are easily available in most urology operating suites. These glide wires are made up of a kink resistant nitinol wire core in a striped jacket which produces an excellent visual feedback. Their flexible polytetrafluoroethylene jacket is designed for torque control. They are available in many sizes, but we chose the 0.032 inch wire as it passes smoothly in the narrow 1.4 mm diameter central lumen of the blocker. It proved effective as it has sufficient length (150 cm) for negotiation through the working channel of FOB as well as the inner channel of the Arndt block

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    Figure 1: Insertion of Arndt bronchial blocker using a zebra urological glide wire

     

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    Figure 2: Zebra glide wire introduced through the accessory port of the fiberoptic bronchoscope
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    Figure 3: Glide wire in the left lower lobe bronchus

     

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    Figure 4: The glide wire is used to railroad the Arndt bronchial blocker

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    Figure 5: The Arndt bronchial blocker is railroaded over the glide wire under the fiberoptic bronchoscope guidance

Read full Article at : Annals of Cardiac Anesthesia

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