Montgomery T-tube removal

MTT is used for stenting the airway after a stenosis correction surgery.The MTT is open at the upper end, though in some cases it might be closed by a cap. A closed MTT is used in complex airway stenosis surgery.Sometimes, the T-tube may get blocked due to dry secretions, mucus plugs and biofilms and must be removed in an emergency situation.

The parents or care givers must have the following material in the event of an emergency MTT removal: 2 artery snaps, clean gauze, tracheostomy cannulae (one of the same size as the outer diameter of the MTT and a second - one size smaller), suction catheters and machine, lubricating jelly / normal saline.

Procedure:

• Use the 2 artery snaps to firmly hold the external limb of the MTT
• Quickly, pull the limb outwards and upwards. There is bound to be resistance and the tube needs to be forcefully pulled out.
• Then, insert an appropriate size tracheostomy canula lubricated with jelly or normal saline. Stretch the tracheostoma site and the surrounding skin in the direction that would spread apart and open it adequately to insert the canula
• Secure the canula with ties.
• Contact your ENT doctor and the Lausanne airway team.
• Remember, do not panic – just quickly pull the blocked tube out and insert a new tracheostomy canula.

Here, we share with you 2 cases showing the MTT removal: See video

• The first video shows removal of the tube.
• The subsequent video shows removal of a modified MTT and insertion of a tracheostomy canula.