Use of the Arndt Wire–guided Endobronchial Blocker

To the Editor:—

The Arndt fiberoptically directable, wire-guided endobronchial blocker (William Cook Europe A/S, Bjaeverskor, Denmark) is a useful tool to achieve one-lung ventilation with an endotracheal tube in a variety of clinical settings. 1The endobronchial blocker is placed coaxially through a conventional endotracheal tube using a pediatric bronchoscope and a special bronchoscopy port. The special bronchoscopy port offers multiple access ports, allowing simultaneous introduction of the bronchoscope and the endobronchial blocker while maintaining ventilation of the lungs. The endobronchial port (wire-guided endobronchial blocker port), which is oriented at 30° to the bronchoscopy port, has a Tuohy-Borst–type valve that locks the blocker in place and maintains an airtight seal. The elliptical balloon of the blocker must be deflated and the wire-guided endobronchial blocker port unthreaded before removing the endobronchial blocker.

After successfully using the wire-guided endobronchial blocker system for one-lung ventilation, we encountered resistance at the level of the Tuohy-Borst valve on attempting to remove the deflated blocker. After ensuring that the valve was fully open, the blocker was pulled out, but the balloon was sheared from the catheter. The special bronchoscopy port was quickly disconnected from the endotracheal tube, and the sheared balloon was recovered in one piece (fig. 1).

Based on our experience, we suggest removing the valve cap before removing the endobronchial blocker.