Esophageal foreign body removal with foley catheter: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "Pt " to "Patient ") |
Neil.m.young (talk | contribs) (Text replacement - " pt " to " patient ") |
||
| Line 31: | Line 31: | ||
*Localize FB on XR or Fluoro, if available | *Localize FB on XR or Fluoro, if available | ||
*Give sedation as needed (ketamine is ideal in kids) | *Give sedation as needed (ketamine is ideal in kids) | ||
*Place | *Place patient in Trendelenberg, supine, lat decub, or prone | ||
*Check balloon for symmetric inflation | *Check balloon for symmetric inflation | ||
*For a child, advance a 12-16F foley orally with balloon deflated | *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) | *Advance tip distal to object (if fluoro is used, inject with contrast to view tip) | ||
*Inflate balloon with 3-5 cc saline | *Inflate balloon with 3-5 cc saline | ||
*Stop inflation if | *Stop inflation if patient complains of pain | ||
*Apply gentle traction to bring coin proximally | *Apply gentle traction to bring coin proximally | ||
*Terminate attempt if there is excessive friction | *Terminate attempt if there is excessive friction | ||
*If the balloon slips past the object, try again with an additional 1-2cc saline in balloon | *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 | *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. | *If no FB is removed, obtain another XR to see if the object passed to the stomach or moved. | ||
| Line 51: | Line 51: | ||
==Disposition== | ==Disposition== | ||
*No f/u needed for pediatric patients, if FB successfully removed and | *No f/u needed for pediatric patients, if FB successfully removed and patient remains asymptomatic | ||
*Arrange f/u for gastric FB's | *Arrange f/u for gastric FB's | ||
*If unsuccessful, refer for immediate endoscopy | *If unsuccessful, refer for immediate endoscopy | ||
Revision as of 14:13, 2 July 2016
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 f/u needed for pediatric patients, if FB successfully removed and patient remains asymptomatic
- Arrange f/u for gastric FB's
- If unsuccessful, refer for immediate endoscopy
- All adults should be referred for endoscopy to r/o esophageal pathology
See Also
References
- Roberts: Clinical Procedures in EM, 5th