Legal Eagle Eye Newsletter for the Nursing Profession (7)5 May 99

   Quick Summary: Seeing the patient biting at his endotracheal tube, the recovery-room nurse should have obtained a bite block and called the anesthesiologist or another physician for guidance.

   Accidents almost invariably are surprises.

   There is some risk of harm if an endotracheal tube is occluded or impaired.  SUPREME COURT OF TENNESSEE, 1998.

   Right after coronary bypass surgery the patient was taken to the recovery room. He was still intubated.

   The recovery room nurse noted that he was awake and nodded in response to questions, but also that he was agitated, was fighting with the monitor wires and was biting at his endotracheal tube.

   The patient completely bit through the tube, leaving part of it lodged in his trachea. The nurse called a respiratory therapist. The two of them worked to remove the broken piece and to re-intubate the patient. However, he had a cardiac arrest and died while they were working on him.

   Despite testimony that in twenty thousand surgical recoveries no one at the hospital had ever seen a patient bite all the way through an endotracheal tube, the Supreme Court of Tennessee faulted the recovery-room nurse for failing to foresee that it could happen to this patient.

   The court believed the nurse should have put a bite block between the patient’s teeth, and called a physician for instruction or assistance. Moon v. St. Thomas Hospital, 983 S.W. 2d 225 (Tenn., 1998).