Using angle connector? Be careful: A hazard note.

Sir,

Various problems associated with breathing circuit such as leakage, obstruction or kinking, condensation of water, and oxygen delivery devices have been reported earlier.[1234] It is important to have a random check of lifesaving equipment supplied in the hospital. Although the supplied materials fulfill the country's rules and regulations, as an end user, quality has to be reconfirmed. The angle connector with side port is most commonly used in operation theater for end-tidal CO2 monitoring. This is also used in case of critical care areas to avoid repeated arterial sampling for the assessment of carbon dioxide levels. In our case, during a routine inspection, the angle connector of breathing system was normal in appearance externally [Figure 1a], but a plastic projection was found inside the lumen [Figure 1b]. This could be mainly due to the improper manufacturing or lack of quality check. If at all it is used on patient, the problems that may occur are increase in airway resistance and aspiration of the dislodged plastic projection leading to obstruction of airways and collapse of pulmonary segments. Such conditions may lead to life-threatening complications and are rare to diagnose. Rising competition in pricing of medical equipment may lead to compromised or low-quality production. As an end user, we should have a high index of suspicion to identify such problems and should make a habit of quality checking of the materials supplied.

Figure 1

Angle connector (a) normal external appearance (b) inside view - plastic projection (arrow)

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