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Airflow efficacy of ballpoint pen tubes: a consideration for use in bystander cricothyrotomy
  1. David Owens1,
  2. Ben Greenwood1,
  3. Alistair Galley1,
  4. Alun Tomkinson2,
  5. Sarah Woolley3
  1. 1Princess of Wales Hospital, Bridgend, Wales, UK
  2. 2University Hospital of Wales, Cardiff, Wales, UK
  3. 3Bristol Royal Infirmary, Bristol, England, UK
  1. Correspondence to David Owens, Princess of Wales Hospital, Bridgend, Wales CF31 1RQ, UK; alnwick2{at}


Objective To examine the suitability of commonly available ballpoint pens as a substitute emergency tracheostomy tube.

Methods commonly 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.

Results Internal 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.

Conclusion Contrary 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.

  • Airway
  • ballpoint pens
  • cricothyroidotomy
  • emergency
  • emergency care system, nursing
  • prehospital
  • prehospital care
  • temporary
  • trauma

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.