inforMED
MalfunctionJAY

BITE PROOF BITE BLOCK

Received Jan 30, 2017 · Event occurred Dec 22, 2016

Report 6285520 · MDR key 6285520

Device

Generic name

Support, Breathing Tube

Catalog number

11160

Lot number

UNKNOWN

Product problems

  • Detachment Of Device Component
  • Component Falling

Patient

78 YR

  • Discomfort
  • Foreign Body In Patient
  • Discomfort
  • Foreign Body In Patient

Narrative

Description of Event or Problem

WHILE ET TUBE WAS BEING ADVANCED, PATIENT BECAME AGITATED AND THE BLUE CAP ON THE ZIP TIE THAT HOLDS THE HOLLISTER ENDOTRACHEAL TUBE HOLDER (BITE BLOCK) FELL INTO PATIENT'S MOUTH. RN AND RESPIRATORY THERAPIST USED FLASHLIGHT TO TRY TO LOCATE CAP WITHOUT SUCCESS. THE DOCTOR WAS NOTIFIED AND ENT CONSULT ORDERED. BEFORE ENT ARRIVED, THE PATIENT COUGHED AND CAP WAS THEN VISIBLE IN MOUTH AND WAS REMOVED. NO HARM TO PATIENT. BEING DISCUSSED IN SYSTEMWIDE RT MTG RE DANGER OF THIS SMALL TIP.