"Utley Maneuver"

Q: What is "The little dutch boy maneuver" or the "Utley Maneuver"?



Answer: 

Tracheo-innominate artery fistula is the most dreaded complication of tracheostomy, as tracheal tube tip (or cuff) erodes into the anterior wall of the trachea resulting in a fistula communication with the innominate artery.

Innominate artery passes anteriorly across the trachea.

This is considered to be a clinical diagnosis, as bleeding can be so abrupt and massive that there may not be anytime for diagnostic workup. 

"The little dutch boy maneuver" is a bedside maneuver when a finger can be placed through the tracheostomy stoma, positioned distally into the trachea, and the finger is then pulled anteriorly to compress the artery against the sternum. Substantial pressure should be applied to tamponade the artery (sufficient to lift the torso anteriorly) - till patient can be rushed to OR for emergent repair.

Other less aggressive bedside maneuvers include 

• overinflation of tracheostomy cuff
• Oral re-intubation and pass Endotracheal tube (ETT) distal to the tracheostomy site and overinflate the cuff.

During all these high drama scenarios, focus should be maintained on patient's oxygenation either via tube or bag mask ventilation.


Reference:

1. Ridley, R. W.; Zwischenberger, J. B. (2006-08-01). "Tracheoinnominate fistula: surgical management of an iatrogenic disaster". The Journal of Laryngology & Otology. 120 (8): 676–680.