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Removal Of Open Safety Pins From The Trachea And Bronchi

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Removal of a closed safety pin presents no difficulty if it is grasped

at one or the other end. A grasp in the middle produces a toggle

and ring action which would prevent extraction. When the

safety pin is open with the point downward care must be exercised

not to override it with the bronchoscope or to push the point through

the wall. The spring or near end is to be grasped with the side-curved

or the rotation forcep
(Figs. 19, 20 and 31) and pulled into the

bronchoscope, thus closing the pin. An open safety pin lodged point up

presents an entirely different and a very difficult problem. If

traction is made without closing the pin or protecting the point

severe and probably fatal trauma will be produced. The pin may be

closed with the pin-closer as illustrated in Fig. 37, and then removed

with forceps. Arrowsmith's pin-closer is excellent. Another method

(Fig. 87) consists in bringing the point of the safety pin into the

bronchoscope, after disengaging the point with the side curved

forceps, by the author's inward rotation method. The forceps-jaws

(Fig. 21) devised recently by my assistant, Dr. Gabriel Tucker, are

ideal for this maneuver. As the point is now protected, the spring,

seen just off the tube mouth, is best grasped with the rotation

forceps, which afford the securest hold. The keeper and its shaft are

outside the bronchoscope, but its rounded portion is uppermost and

will glide over the tissues without trauma upon careful withdrawal of

the tube and safety pin. Care must be taken to rotate the pin so that

it lies in the sagittal plane of the glottis with the keeper placed

posteriorly, for the reason that the base of the glottic triangle is

posterior, and that the posterior wall of the larynx is membranous

above the cricoid cartilage, and will yield. A small safety-pin may be

removed by version, the point being turned into a branch bronchial

orifice. No one should think of attempting the extraction of a safety

pin lodged point upward without having practiced for at least a

hundred hours on the rubber tube manikin. This practice should be

carried out by anyone expecting to do endoscopy, because it affords

excellent education of the eye and the fingers in the endoscopic

manipulation of any kind of foreign body. Then, when a safety pin case

is encountered, the bronchoscopist will be prepared to cope with its

difficulties, and he will be able to determine which of the methods

will be best suited to his personal equation in the particular case.

[FIG. 86.--Schema illustrating the upper-lobe-bronchus problem,

combined with the mushroom-anchor problem and the author's method

for their solution. The patient being recumbent, the bronchoscopist

looking down the right main bronchus, M, sees the point of the tack

projecting from the right upper-lobe-bronchus, A. He seizes the point

with the side-curved forceps; then slides down the bronchoscope to the

position shown dotted at B. Next he pushes the bronchoscopic

tube-mouth downward and medianward, simultaneously moving the

patient's head to the right, thus swinging the bronchoscopic level on

its fulcrum, and dragging the tack downward and inward out of its bed,

to the position, 1). Traction, as shown at C, will then safely and

easily withdraw the tack. A very small bronchoscope is essential. The

lip of the bronchoscopic tube-mouth must be used to pry the forceps

down and over, and the lip must be brought close to the tack just

before the prying-pushing movement. S, right stem-bronchus.]

[FIG. 87.--One method of dealing with an open safety pin without

closing it.]