November 23, 2018

Swallowed Coin Removal without Sedation Using a Foley in a Young Child



A blog subscriber recently informed me about a video showing a coin being removed blindly from a young child using only a foley catheter without any sedation. Watch video above...

This blind removal technique basically involves passing a small foley catheter through the mouth and PAST where the coin is located within the esophagus, typically behind the voicebox. The foley catheter balloon which would then be located past where the coin would be, is then inflated with a syringe. After balloon inflation, the catheter is then pulled out the mouth along with stuck coin which is pushed along by the inflated catheter balloon.

If this technique works, it works great, but there are a few caveats that may impact outcome... even cause significant complications, that healthcare professionals should be aware of.

   #1: Confirm coin location in the upper esophagus typically with a Neck X-ray. If the coin is located further down the esophagus, the chance the foley catheter balloon gets past the coin is much lower.

   #2: Ensure the foley catheter is in the esophagus! It's entirely possible that the foley catheter could go into the the trachea instead of the esophagus in which case, significant laryngeal damage may occur with pulling an inflated foley catheter balloon out past the vocal cords... and the coin will still be stuck in the throat. Accidental insertion into the windpipe may also trigger laryngospasm. A safer variation of the coin removal with a foley is to insert the foley catheter under fluoroscopic guidance to ensure correct placement.

  #3: If significant mucosal edema has developed around the stuck coin, forcibly pulling the coin out may traumatize the esophageal mucosa at best causing prolonged swallowing problems or it can even potentially perforate the esophagus at worst.

   #4: The coin may become displaced into the upper airway during removal where it could potentially cause breathing problems whether from direct obstruction or laryngospasm. To minimize this from happening, patient should have been placed in a head-down position on his side (like you would for a patient who is having a seizure to prevent aspiration).

At least in the United States, the standard way to remove swallowed coins in children is via direct visualization under sedation which eliminates many of the potential complications of blind removal (airway secured, coin removed securely while making sure does not lead to further esophageal injury, etc). Unfortunately, not all hospitals have pediatric equipment to perform such direct extractions and as such, this technique of blind coin removal can be considered the next best step to take.

References:
Removal of Coins in the Esophagus Using a Foley Catheter. Pediatrics September 1972, VOLUME 50 / ISSUE 3

Esophageal foreign bodies: safety and efficacy of Foley catheter extraction of coins. AJR Am J Roentgenol. 1997 Feb;168(2):443-6.

Removal of esophageal foreign bodies with a Foley balloon catheter under fluoroscopic control. CMAJ. 1987 Jul 15;137(2):125-7.

Foley catheter extraction of blunt esophageal foreign bodies. J Emerg Med. 1986;4(4):301-6.

A safe alternative to endoscopic removal of blunt esophageal foreign bodies. Arch Otolaryngol. 1983 May;109(5):323-5.

Blind Esophageal Coin Removal Using a Foley Catheter. Arch Surg. 1968;96(6):931-932. doi:10.1001/archsurg.1968.01330240077017

Pharyngeal coin removal in children. JAccid Emerg Med 1997;14: 175-176

Esophageal Foreign Bodies: Safety and Efficacy of Foley Catheter Extraction of Coins. AJR 1997;168:443-446


Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. He is also the chief medical officer of O2Labz, a medical and scientific 3D animation company.Google+ Christopher Chang, MD Bio

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