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. 2025 Mar 31;18(1):65.
doi: 10.1186/s12245-025-00865-9.

Complication management in percutaneous dilatational tracheostomy: a case of tracheal needle sheath retrieval

Sritam Mohanty  1 , Biswajit Nayak  1 , Samir Samal  1 , Sagarika Panda  2 , Shakti Bedanta Mishra  1 , Satyajit Choudhury  1
Affiliations

Complication management in percutaneous dilatational tracheostomy: a case of tracheal needle sheath retrieval

Sritam Mohanty et al. Int J Emerg Med. .

Abstract

Background: Percutaneous dilatational tracheostomy (PDT) is a widely performed procedure in intensive care units (ICUs) for patients requiring prolonged mechanical ventilation. Although generally safe, PDT carries risks of complications, some of which may be life-threatening. Foreign body aspiration is a well-known concern, but the iatrogenic migration of procedural components, such as a tracheostomy needle sheath, has received little attention.

Case presentation: We report the case of a male patient with intracerebral hemorrhage (ICH) who underwent a percutaneous dilatational tracheostomy. During the procedure, the sheath of the tracheostomy needle became dislodged and migrated into the tracheobronchial tree. Urgent intervention was required to prevent further complications. Bronchoscopy was promptly performed at the bedside, revealing the foreign body in the right main bronchus. Initial retrieval attempts using biopsy forceps were unsuccessful due to the sheath's positioning. The sheath was eventually maneuvered into the endotracheal tube (ETT) and extracted in a coordinated manner with the simultaneous removal of the ETT and forceps. The tracheostomy tube was then successfully placed under bronchoscopic guidance, and the patient remained stable without further complications.

Conclusion: This case highlights a rare and potentially life-threatening complication of PDT, emphasizing the essential role of bronchoscopy in managing intraprocedural complications. It underscores the importance of procedural expertise and vigilance in ICU settings.

Keywords: Airway management and tracheostomy complications; Bronchoscopy; Foreign body retrieval.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient’s next of kin to publish this case report and accompanying images. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Tracheostomy Needle Sheath at the Carina entering the Right Primary Bronchus
Fig. 2
Fig. 2
Tracheostomy Needle Sheath at The Carina being extracted by aBiopsy Forceps
Fig. 3
Fig. 3
Tracheostomy Needle Sheath extracted through the endotracheal tube by a Biopsy Forceps
See this image and copyright information in PMC

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