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To the Editor.—Lewy, in his article entitled "Increased Safety in Tracheotomy Tube Replacement" published in the May Archives (1982;108:327), suggested increased safety could be achieved by using an indwelling nasogastric tube as an obturator while changing tracheotomy tubes. He suggested a nasogastric tube approximately twice the length of the tracheotomy tube would be necessary to achieve safe replacement.
I would suggest that a tube at least three times the length of the tracheotomy tube is necessary. Examining Dr Lewy's Fig 4, there is a period during insertion of the new tracheotomy tube, when the nasogastric obturator can be forced into the lumen of the airway, thus creating a foreign body. I would suggest, if the obturator were three times the length of the tracheotomy tube, it could always be grasped externally, either beyond the flange of the tube or between the distal lumen of the tube and the skin,
COHEN RS. Tracheotomy Tube Replacement. Arch Otolaryngol. 1983;109(1):62. doi:10.1001/archotol.1983.00800150066016
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