Esophageal foreign body removal with foley catheter: Difference between revisions
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==Background== | ==Background== | ||
*85-100% success rates | |||
*0-2% complication rates | |||
*Ideal for coins | |||
*No reports of airway compromise | |||
==Indications== | ==Indications== | ||
*Recently ingested (<24-48h), smooth, blunt, radiographically opaque objects | |||
*Button batteries ingested <2h with no endoscopy available | |||
==Contraindications== | ==Contraindications== | ||
*Total esophageal obstruction | |||
**Air-Fluid levels on XR or esophagram | |||
**Pt 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== | ==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== | ==Procedure== | ||
*Localize FB on XR or Fluoro, if available | |||
*Give sedation as needed (ketamine is ideal in kids) | |||
*Place pt 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 pt 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 pt to expectorate it | |||
*If no FB is removed, obtain another XR to see if the object passed to the stomach or moved. | |||
==Complications== | ==Complications== | ||
*Most are due to passage of foley through nose | |||
**Nosebleed | |||
**Displacement of FB to nasopharynx | |||
*Laryngospasm and aspiration | |||
*Failure to remove FB | |||
==Disposition== | ==Disposition== | ||
*No f/u needed for pediatric pts, if FB successfully removed and pt remains asx | |||
*Arrange f/u for gastric FB's | |||
*If unsuccessful, refer for immediate endoscopy | |||
*All adults should be referred for endoscopy to r/o esoph path | |||
==See Also== | ==See Also== | ||
| Line 61: | Line 61: | ||
==Source== | ==Source== | ||
*Roberts: Clinical Procedures in EM, 5th | |||
[[Category:procedures]] [[Category:GI]] | [[Category:procedures]] [[Category:GI]] | ||
Revision as of 22:07, 19 April 2015
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 esophagram
- Pt 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 pt 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 pt 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 pt 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 f/u needed for pediatric pts, if FB successfully removed and pt remains asx
- Arrange f/u for gastric FB's
- If unsuccessful, refer for immediate endoscopy
- All adults should be referred for endoscopy to r/o esoph path
See Also
Source
- Roberts: Clinical Procedures in EM, 5th