Which is the most common complication after ET tube removal?

NORCET 5 Prelims - Sept 2023 (Shift-1)

Medical Surgical Nursing

Easy

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

Explanation

Sore throat is the most frequent complication following extubation, reported by a high percentage of patients.
It is caused by the mechanical irritation and pressure exerted by the endotracheal tube and its cuff on the sensitive mucosal tissues of the pharynx, larynx, and trachea.
The inflammation from this irritation leads to pain and discomfort upon swallowing, which is typically mild and resolves within 24 to 48 hours.
The principle of mucosal irritation from indwelling tubes is a common clinical finding, as noted with nasogastric tubes as well.

Option A: Malposition refers to the incorrect placement of the ET tube, such as insertion into the esophagus or the right mainstem bronchus.
Option B: The abducent nerve (Cranial Nerve VI) controls the lateral rectus muscle of the eye and has no anatomical pathway near the trachea or larynx.
Option C: While minor trauma during extubation can cause some blood-streaked sputum, significant bleeding is an uncommon and serious complication.

Visual 1: Diagram: A sagittal view of the head and neck with an endotracheal tube correctly positioned. Arrows can point to the areas of contact and potential irritation: the posterior pharynx, the vocal cords, and the tracheal wall where the cuff inflates. The caption should read: 'Anatomical points of irritation from an endotracheal tube leading to post-extubation sore throat.'

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.
A nurse's primary role post-extubation is to monitor for airway compromise while providing comfort measures for common, minor side effects like a sore throat.
Patient education is key. Reassuring the patient that a sore throat is normal and temporary can reduce anxiety, while instructing them to report difficulty breathing is crucial for safety.
What if? If the patient develops a harsh, high-pitched crowing sound on inspiration (stridor) after extubation, this is not a common sore throat. It signifies severe laryngeal edema, a medical emergency that requires immediate intervention, including possible re-intubation, to prevent complete airway obstruction.

How to Approach the Question

First, identify the keywords in the question: 'most common complication' and 'ET tube removal' (extubation).
Consider the physical process of extubation: a tube is being pulled out of the throat. Think about the most direct and likely consequence of this action.
Evaluate each option's plausibility. A sore throat is a direct result of irritation from a foreign body in the pharynx.
Analyze the distractors. 'Malposition' relates to tube placement, not removal. 'Abducent injury' is anatomically incorrect. 'Bleeding' is possible but less likely to be the most common outcome compared to simple irritation.
Conclude that the most frequent and predictable side effect of having a tube in the throat is irritation, which manifests as a sore throat.

Concept Tested & Keywords

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