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UK MDA (Medical Devices Agency) warns of respiratory device misassembly:

This article was originally published in Clinica

Executive Summary

The UK Medical Devices Agency (MDA) has renewed warnings of the danger of using misassembled endotracheal and tracheostomy tubes, in light of "an increasing number of reports of barotrauma". In a hazard notice issued last week, the MDA urges that whenever respiratory therapy devices are connected to endotracheal or tracheostomy tubes, staff ensure there is free passage of expired gases and that assembly be undertaken only by appropriately trained staff. The agency reports two new related incidents, with "serious consequences". In one case, a disposable nebuliser chamber was connected directly onto the patient's tracheal tube. In the other, an oxygen therapy connector was connected to a breathing system filter, directly attached to the patient's endotracheal tube. Incorrectly assembling a respiratory therapy device to a tight-fitting facemask poses similar hazards.

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