Esophageal foreign body removal with foley catheter: Difference between revisions
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==Indications== | ==Indications== | ||
*Recently ingested (<24-48h), smooth, blunt, radiographically opaque objects | *Recently [[ingested foreign body|ingested]] (<24-48h), smooth, blunt, radiographically opaque objects | ||
*Button batteries ingested <2h with no endoscopy available | *Button batteries ingested <2h with no endoscopy available | ||
Revision as of 16:06, 9 October 2019
Background
- 85-100% success rates
- 0-2% complication rates
- Ideal for coins
- No reports of airway compromise
Indications
- Recently ingested (<24-48h), smooth, blunt, radiographically opaque objects
- Button batteries ingested <2h with no endoscopy available
Contraindications
- Total esophageal obstruction
- Air-Fluid levels on XR or esophagogram
- Patient unable to handle secretions
- Presence of FB greater than 24-48h (higher risk of pressure necrosis)
- Evidence of esophageal perforation
- Airway distress
- Multiple FB's
- Sharp FB's
- Button battery present >2 hours
Equipment Needed
- Airway equipment and suction
- Magill and bayonet forceps
- Foley size 10-16F with 5cc to 10cc balloon
- Topical anesthetics
- Sedation meds
- Pediatric restraint devices
Procedure
- Localize FB on XR or Fluoro, if available
- Give sedation as needed (ketamine is ideal in kids)
- Place patient in Trendelenberg, supine, lat decub, or prone
- Check balloon for symmetric inflation
- For a child, advance a 12-16F foley orally with balloon deflated
- Advance tip distal to object (if fluoro is used, inject with contrast to view tip)
- Inflate balloon with 3-5 cc saline
- Stop inflation if patient complains of pain
- Apply gentle traction to bring coin proximally
- Terminate attempt if there is excessive friction
- If the balloon slips past the object, try again with an additional 1-2cc saline in balloon
- Once coin is in mouth grab with forceps or ask patient to expectorate it
- If no FB is removed, obtain another XR to see if the object passed to the stomach or moved.
Complications
- Most are due to passage of foley through nose
- Nosebleed
- Displacement of FB to nasopharynx
- Laryngospasm and aspiration
- Failure to remove FB
Disposition
- No follow up needed for pediatric patients, if FB successfully removed and patient remains asymptomatic
- Arrange follow up for gastric FB's
- If unsuccessful, refer for immediate endoscopy
- All adults should be referred for endoscopy to rule out esophageal pathology