Ver el código de «Esophageal foreign body removal with foley catheter»

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==Background==

[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]]
*85-100% success rates
*0-2% complication rates
*Ideal for coins
*No reports of airway compromise


==Indications==

*Recently [[Special:MyLanguage/ingested foreign body|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


==See Also==

*[[Special:MyLanguage/Esophageal foreign body|Esophageal foreign body]]
*[[Special:MyLanguage/Foreign bodies|Foreign bodies]]


==External Links==


===Videos===

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==References==

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[[Category:Procedures]]
[[Category:GI]]
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