Which is the most common complication after ET tube removal?

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

Sore throat is the most frequent complication after extubation.
The endotracheal tube directly irritates the mucous membranes of the pharynx and larynx, leading to inflammation and pain upon removal.
This discomfort is usually mild and self-limiting, resolving within 24-48 hours.
Comfort measures such as ice chips, cool liquids, and throat lozenges (if the patient's condition permits) can help alleviate the soreness.

Option A: Malposition refers to the incorrect placement of the ET tube, such as in the esophagus or right mainstem bronchus.
Option B: The abducent nerve (Cranial Nerve VI) controls lateral eye movement and is not located in the pathway of the ET tube.
Option C: While minor, blood-tinged sputum can occur from mucosal irritation, significant bleeding is not the most common complication.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Endotracheal Extubation as background academic context rather than a clinical decision trigger.
Post-extubation, the nurse's priority is to assess for airway patency. While a sore throat is expected, any signs of respiratory distress, such as stridor, wheezing, or decreased oxygen saturation, must be reported immediately.
Nursing interventions for a sore throat include providing comfort measures like ice chips, humidified oxygen, and encouraging voice rest.
What if? If the patient develops stridor after extubation, this indicates severe laryngeal edema and potential airway obstruction. The nurse should immediately notify the respiratory therapist and physician, prepare for emergency re-intubation, and administer prescribed treatments like racemic epinephrine or corticosteroids.

How to Approach the Question

First, identify the core of the question: it asks for the 'most common' complication specifically after 'ET tube removal' (extubation).
Evaluate each option based on its relationship to the procedure of extubation.
Eliminate 'Malposition' as it is a complication of intubation (placing the tube), not extubation.
Consider the anatomy. The ET tube passes through the throat. Direct physical irritation makes a 'Sore throat' a highly probable and frequent outcome.
Evaluate the other options. 'Abducent injury' is anatomically unlikely. 'Bleeding' is possible but less frequent than simple irritation.
Conclude that the most common and direct consequence of having a tube in the throat is a sore throat after it's removed.

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 351-353, 352-354

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