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Lesson of the month: management for aspiration of a silver nitrate pencil tip during tracheostomy care
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  • Published on:
    ‘Better safe than sorry’
    • Stijn Bekkers, Resident Otolaryngology—Head and Neck Surgery Radboud University Medical Center
    • Other Contributors:
      • Johannes Adriaan Rijken, Otolaryngologist & Head and Neck surgeon

    With great interest we have read the study by Deshayes et al. The authors present two cases of silvernitrate (AgNO3) aspiration in laryngectomized patients.
    1) In both cases the applicator tip broke off.
    2) The authors conclude that treatment should comprise oral antibiotics and one should refrain from bronchial washing with sodium chloride solution.
    With this response we would like to reply to both points addressed above.
    1.
    Five years ago we were confronted with the aspiration of an AgNO3 applicator tip in a laryngectomized patient. After the incident we analyzed the case to prevent future AgNO3 applicator tip aspiration. The AgNO3 pencil, used in both our case and the cases in the current article, is specifically designed to treat dermal lesions like verruca which requires repeated use. The pencil therefore contains a relatively large volume of AgNO3. AgNO3 is a brittle substance. When the pencil is used with a little too much pressure there is risk for the tip to break, and when used in a tracheostomy, there is risk for aspiration.
    Our case led us to immediately stop using the AgNO3 pencils for treatment of granulation tissue in a tracheostomy. We strongly recommend the use of disposable AgNO3 cutaneous sticks for the treatment of granulation tissue around a tracheostomy. The disposable sticks contains less volume of AgNO3. Moreover, the stick is easier to use in narrow spaces like a tracheostomy.
    2.
    Aspiration of AgNO3 i...

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    Conflict of Interest:
    None declared.