Rupture of Obstructed Nasal Cannula

Diane Foos, CRNA

Letter to the Editor:

nasal cannula

Figure 1. Ruptured Nasal Canula.

To the Editor:

Today, I provided IV sedation to a patient who was having a closed reduction of a nasal fracture. I placed a nasal cannula with oxygen and ETCO2 monitoring in the patient’s mouth. While the surgeon was infiltrating the nose with local anesthesia, I noticed that the patient’s SpO2 had decreased and the adjunct oxygen flow meter that had been set at 4 liters/min was now set at zero. I attempted unsuccessfully to increase the oxygen flow. Failure of the oxygen supply was ruled out because the oxygen flow meter on the anesthesia machine was working. Subsequently, there was a loud pop that got everyone’s attention.

As you can see from the photo that is attached, the nasal cannula ruptured. The patient had clenched his teeth on the nasal prongs, biting off a small piece. The surgeon retrieved the piece of plastic from the patient’s tongue. We suspect that when the cannula was occluded, enough pressure from the flow of oxygen caused the cannula to rupture.

Although I have placed the nasal cannula in the mouth many times for nasal procedures, this had never occurred. In the future, I intend to use an oral airway or bite block if the cannula cannot be placed in the nose.

Sincerely, Diane Foos, CRNA Abington Surgical Center Willow Grove, PA