[1441258]
During the intubation procedure, the anesthesiologist used an atomization device to spray the patient's vocal cords with lidocaine. He placed the device in position and asked the nurse assisting him to spray the lidocaine by pushing the syringe. During this procedure, the nurse pushed and felt momentary resistance and then there was nothing. The syringe emptied too quickly and did not spray as usual. Anesthesiologist then got another atomization device and it appeared to function correctly. As nurse was throwing the two devices away, she noticed that one of them did not have the little plastic tip on the end of it, like the other one did. The anesthesiologist was notified and became concerned that the small plastic tip may have come off in the patient. The surgeon was notified and a laryngoscopy and flexible bronchoscopy was performed with no foreign object (plastic tip) noted. A chest x-ray was ordered and patient was monitored in recovery. No adverse patient affect. Had not seen this problem before but manufacturer found two other occurrences in their stock of products. Manufacturer response (as per reporter) for laryngo-tracheal mucosal atomization device, madgic manufacturer came to facility to pick up defective product for evaluation. Indicated assembly line staff have undergone retraining.
 Patient Sequence No: 1, Text Type: D, B5