Esophageal foreign body removal with foley catheter

Background

1. 85-100% success rates
2. 0-2% complication rates
3. Ideal for coins
4. No reports of airway compromise

Indications

1. Recently ingested (<24-48h), smooth, blunt, radiographically opaque objects
2. Button batteries ingested <2h with no endoscopy available

Contraindications

1. Total esophageal obstruction
   1. Air-Fluid levels on XR or esophagram
   2. Pt unable to handle secretions
2. Presence of FB greater than 24-48h (higher risk of pressure necrosis
3. Evidence of esophageal perforation
4. Airway distress
5. Multiple FB's
6. Sharp FB's
7. Button battery present >2 hours

Equipment Needed

1. Airway equipment and suction
2. Magill and bayonet forceps
3. Foley size 10-16F with 5cc to 10cc balloon
4. Topical anesthetics
5. Sedation meds
6. Pediatric restraint devices

Procedure

1. Localize FB on XR or Fluoro, if available
2. Give sedation as needed (ketamine is ideal in kids)
3. Place pt in Trendelenberg, supine, lat decub, or prone
4. Check balloon for symmetric inflation
5. For a child, advance a 12-16F foley orally with balloon deflated
6. Advance tip distal to object (if fluoro is used, inject with contrast to view tip)
7. Inflate balloon with 3-5 cc saline
8. Stop inflation if pt complains of pain
9. Apply gentle traction to bring coin proximally
10. Terminate attempt if there is excessive friction
11. If the balloon slips past the object, try again with an additional 1-2cc saline in balloon
12. Once coin is in mouth grab with forceps or ask pt to expectorate it
13. If no FB is removed, obtain another XR to see if the object passed to the stomach or moved.

Complications

1. Most are due to passage of foley through nose
   1. Nosebleed
   2. Displacement of FB to nasopharynx
2. Laryngospasm and aspiration
3. Failure to remove FB

Disposition

1. No f/u needed for pediatric pts, if FB successfully removed and pt remains asx
2. Arrange f/u for gastric FB's
3. If unsuccessful, refer for immediate endoscopy
4. All adults should be referred for endoscopy to r/o esoph path

See Also

• Esophageal Foreign Body
• Foreign body

Source

1. Roberts: Clinical Procedures in EM, 5th