Pulmonary Procedures |

Where Is The Rest of That Needle? Needle Breakage: A Rare Complication of EBUS-TBNA FREE TO VIEW

Deepankar Sharma, MD; Chee Hong Loh, MD; Christina Bellinger, MD
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Wake Forest University School of Medicine, Winston Salem, NC

Chest. 2015;148(4_MeetingAbstracts):837A. doi:10.1378/chest.2263694
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SESSION TITLE: Procedures Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique that provides real time visualization and aspiration of lesions and lymph nodes adjacent to the trachea and large bronchi. EBUS-TBNA is being performed for several indications including suspected malignancy, mediastinal staging of lung cancer and suspected sarcoidosis. Apart from known complications like bleeding and infections others like mediastinal abscess, empyema and lung abscess have been reported in form of case reports. But, only one case of needle breakage has been reported in literature so far and we report second such case.

CASE PRESENTATION: A 55 year old man with biopsy proven sarcoidosis was scheduled for an EBUS-TBNA under general anesthesia for mediastinal lymphadenopathy and new bilateral lung nodules. EBUS-TBNA was performed using a COOK ECHO-HD-22-EBUS-P needle. After first two passes at 10R node, we encountered difficulty in advancing the needle into the 4R node. The needle did not appear bent or kinked. During the subsequent pass, the needle was advanced 3 cms but was only seen up to 1.5 cms within the node. The needle was then withdrawn and examined which revealed a breakage of distal 1.5 cms segment. The EBUS scope was exchanged with a therapeutic bronchoscope and the distal end of the needle was seen lodged in the trachea. It was retrieved using alligator forceps without any difficulty. No bleeding was noticed at the site and the procedure was completed using a different EBUS-TBNA needle. Patient did not suffer from any complication and was discharged home after the procedure.

DISCUSSION: Needle breakage is a rare complication of EBUS-TBNA. Our review of literature on PubMed revealed only one such case report. We also reviewed FDA’s Manufacturer and User Facility Device Experience (MAUDE) database from last 5 years which revealed 13 such cases with OLYMPUS 21G, 22G and COOK 22G and 25G needles. In all the reported cases, the needle was retrieved during the procedure except one where the patient had to undergo surgery and the needle could not be retrieved and was left in the node.

CONCLUSIONS: Although rare, needle breakage is one of the major potential complications of EBUS-TBNA that a bronchoscopist should be aware of and be prepared to deal with.

Reference #1: An Unusual Complication of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): the Needle Breakage. Özgül MA, Çetinkaya E, Tutar N, Özgül G.

Reference #2: Current status and perspective of EBUS-TBNA. Nakajima T1, Yasufuku K, Yoshino I.

DISCLOSURE: The following authors have nothing to disclose: Deepankar Sharma, Chee Hong Loh, Christina Bellinger

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