Tracheal swab from front of neck airway for SARS-CoV-2; a bronchial foreign body

BMJ Case Rep. 2020 Aug 27;13(8):e237787. doi: 10.1136/bcr-2020-237787.

Abstract

We report the case of a bronchial foreign body, following a tracheostomy site swab for SARS-CoV-2, aiming to raise awareness and vigilance. A qualified nurse was performing a routine SARS-CoV-2 swab on a 51-year-old woman, fitted with a tracheostomy in the recent past following a craniotomy. This was part of the discharging protocol to a nursing home. During the sampling, part of the swab stylet snapped and was inadvertently dropped through the tracheostomy site. Initial CT imaging was reported as showing no signs of a foreign body but some inflammatory changes. Bedside flexible endoscopy through the tracheostomy site revealed the swab in a right lobar bronchus. This was subsequently removed by flexible bronchoscopy. This case highlights the need for clear guidance on how samples for SARS-CoV-2 are taken from patients with front of neck airways (laryngectomy/tracheοstomy) and the potential pitfalls involved.

Keywords: ear; medical-surgical nursing; nose and throat/otolaryngology; otolaryngology / ENT; radiology.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Betacoronavirus
  • Bronchi / diagnostic imaging*
  • Bronchi / surgery
  • Bronchoscopy
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques
  • Coronavirus Infections / diagnosis*
  • Female
  • Foreign Bodies / diagnostic imaging*
  • Foreign Bodies / surgery
  • Humans
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • SARS-CoV-2
  • Specimen Handling / adverse effects
  • Specimen Handling / instrumentation*
  • Tomography, X-Ray Computed
  • Tracheostomy*