Coronavirus swab snaps and gets stuck in tracheostomy patient’s LUNG

Coronavirus swab gets stuck in patient’s LUNG when it snaps and falls into breathing tube put in her neck after surgery

  • Swabs are designed to snap when put into a test tube but not during use
  • The 51-year-old woman had a breathing tube in her neck after skull surgery
  • Doctors had to fish out the swab end after finding it lodged in her lung
  • They warned medics should be cautious about the possibility with such patients 

A coronavirus swab snapped off inside a woman’s lung when it was inserted into a breathing tube she had in her neck, a medical case report has revealed.

The 51-year-old had recently had surgery and had a tracheostomy put in – a tube cut into the throat to help her breathe without using their nose or mouth. 

During a Covid-19 scare while she was in hospital, a nurse tested her for the disease and did so by putting a normal swab in through the hole in her neck because she wasn’t using her nose and mouth so the virus wouldn’t be there if she was infected.

But the swab – which is designed to snap so it can fit into a test tube to be sent to the lab – broke during the procedure.

The end of it fell off and got lodged in the woman’s lung. It was invisible on X-rays and CT scans but medics could see some unusual swelling in her right lung.

When they put a camera into the lung they found the swab lodged in her airway and were able to pull it out with an endoscopy. The doctors are now warning others about the possibility of swabs breaking during use with vulnerable patients.

The doctors managed to find the broken fragment of the swab using a tubular camera inserted into the woman's airway (Pictured: A still from the video showing the white tip of the swab inside the woman's lung)

The doctors managed to find the broken fragment of the swab using a tubular camera inserted into the woman’s airway (Pictured: A still from the video showing the white tip of the swab inside the woman’s lung)

Swabs are designed to snap because they are extra long so they can reach the back of people's throats but only the very tip has to be analysed for traces of coronavirus

Swabs are designed to snap because they are extra long so they can reach the back of people’s throats but only the very tip has to be analysed for traces of coronavirus

‘This case highlights the need for clear guidance on how samples for SARS-CoV-2 are taken from patients with front of neck airways and the potential pitfalls involved,’ the doctors, led by Dr Mohammed Hussain said.

The team were working at the University Hospitals of Leicester NHS Trust when they treated the patient, who is not named in the report.

She had recently had surgery to remove a fragment of her skull for an unrelated illness, and needed the tracheostomy put in to help her breathe.

She was going to be discharged to a care home and needed to have a Covid-19 test result before she could be admitted. 

All patients being discharged from hospitals to care homes are now tested as routine in order to stop them carrying the virus from a hospital to a home, where the residents are the most vulnerable people in the country to dying from Covid-19.

The medics wrote in the journal BMJ Case Reports: ‘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 [swelling]. 

‘Bedside flexible endoscopy through the tracheostomy site revealed the swab in a right lobar bronchus. This was subsequently removed by flexible bronchoscopy.’

The swabs are designed to snap in half when force is applied.

Normally, they are wiped around the inside of the person’s throat and nose and then placed in a test tube, when the handle is snapped off. 

The handle is significantly longer than the test tube because it has to reach the back of the throat without the person giving the test getting too close to the patient, but only the very tip of the swab actually gets the sample on it and needs testing.

The snapped swab did not show up on an X-ray that the medics did after the incident. They described the scan as 'unremarkable'

The snapped swab did not show up on an X-ray that the medics did after the incident. They described the scan as ‘unremarkable’

A CT scan, however, showed an abnormal section of swollen tissue in the lung (shown by the white arrow), which is where the organ had reacted to the irritation caused by the broken swab

A CT scan, however, showed an abnormal section of swollen tissue in the lung (shown by the white arrow), which is where the organ had reacted to the irritation caused by the broken swab

Testers usually have to try to get samples of fluid from the nose and throat because that is where the coronavirus fixes onto the body and multiplies.

But the virus may not make it to those parts of the body if the person is breathing through a tracheostomy, meaning fluid samples must be taken directly from the lungs.

Dr Hussain and colleagues said: ‘The above case highlights the potential dangers of taking a mucosal swab from a trachesotomy site.

‘Heightened concerns around SARS-CoV-2 and wearing full personal protective equipment increase the probability of human error occurring.’ 

WHAT ARE THE DIFFERENT SWAB TESTS FOR COVID-19? 

Nasopharyngeal swabs are used to detect respiratory viruses, such as the flu and the new coronavirus.

It is the preferred choice for SARS-CoV-2 testing, according to the Centers for Disease Control and Prevention (CDC).

It involves inserting a long, flexible cotton bud into the nostril and along the nose ‘floor’. This is supposed to be done slowly so that it is comfortable.

The aim is to reach the posterior nasopharynx, a cavity made up of muscle and connective tissue, covered in cells and mucous that are similar to the nose. It continues down into the throat.

The swab is rotated several times in order to get enough cells.

The sample is then sent to a lab, where it will be tested to determine if the patient’s cells are infected with the virus.

The coronavirus is a RNA virus, which means it uses ribonucleic acid as its genetic material. A process called reverse transcription is needed to transcribe the RNA into readable DNA.

How coronavirus self-tests are conducted: They require the patient to put the swab into the back of their throat and then a short way into their nostril to try and pick up the viruses, which live in the airways

How coronavirus self-tests are conducted: They require the patient to put the swab into the back of their throat and then a short way into their nostril to try and pick up the viruses, which live in the airways

A swab sample doesn’t collect much RNA in one go, therefore a polymerase chain reaction (PCR) is used to rapidly make billions of copies so it can be analysed.

The DNA is dyed a fluorescent colour, which glows if the coronavirus is present, confirming a diagnosis.

Anterior nasal swabs, which are read in the laboratory using the same methods described above, can be carried out by the patient and use a shorter cotton swab. 

The swab only needs to enter the nose to a depth of roughly one centimetre before being rubbed around the nostril wall. 

It is less likely to make the patient feel sick or to produce a gagging or coughing reflex. 

Experts say they have less contact with the mucous membranes, which are areas of thin tissue inside the airways where most of the coronaviruses live. 

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