Airflow efficacy of ballpoint pen tubes: a consideration for use in bystander cricothyrotomy

ObjectiveTo examine the suitability of commonly available ballpoint pens as a substitute emergency tracheostomy tube.Methodscommonly available ballpoint pens were examined and compared against two standard cricothyroidotomy sets. The pens were evaluated for dimensions, speed of construction of a temporary tracheostomy tube and airway resistance with differing flow rates.ResultsInternal diameters of the pens varied considerably. Time taken to construct a temporary tube ranged from 3 to 170 s, and in the majority of pens the airway resistance increased dramatically as the airflow rate increased.ConclusionContrary to popular belief, the majority of ballpoint pens appear unsuitable for use as a substitute tracheostomy tube. In this study only two pens fulfilled the criteria for use: the Baron retractable ballpoint and the BIC soft feel Jumbo.