Fogarty Catheter: An Indispensable Tool to Complement the Ingenuity of the Endoscopist for Extraction of Airway "Foreign Body with a Hole"

Abstract

Introduction: The extraction of smooth spherical objects is challenging as they are difficult to grasp within the jaws of the forceps and tend to slip distally.

Objective: The authors herein have shared their experience with the use of a Fogarty catheter (FC) for safe extraction of smooth and spherical "foreign body (FB) with a hole."

Materials and methods: Report on pediatric cases (n = 4) of airway "FB with a hole" wherein the FC was used for their extraction. Mean age was 27.5 months (range: 17 months-39 months). The male: female ratio was 3:1. The technique of FB extraction with a FC has been described, including the principle of the technique, indications, and contra-indications, technical problems and troubleshooting.

Results: The FB spectrum included a necklace bead (n = 2), nonnecklace bead (n = 1) and a fragmented end-piece of the housing of a ball-pen (n = 1). The locations of the FBs were right main bronchus (n = 1), secondary bronchus on the right (n = 1), and in the left main bronchus (n = 2). Successful removal of FB with use of FC during rigid broncoscopy was possible. The bead had to be rotated in n = 2 patients to align the hole with the FC. Problems associated with threading the hole and disimpaction of the FB have been highlighted. No complications were observed. The advantages and limitation of the technique have been discussed.

Conclusions: The use of FC with the described technique offers a safe, effective and reproducible method for removal of airway "FB with a hole" in a controlled environment while minimizing the possibility of iatrogenic injury to the wall of the surrounding airways.

Keywords: Airway foreign body; Fogarty catheter; kangaroo technique; smooth-surfaced foreign body; spherical foreign body.

Figure 1

The authors suggest keeping a Fogarty catheter as an integral part of bronchoscopy set-up for removal of airway foreign bodys. (Inset): It is important to check that the inflation and deflation mechanism is intact ahead of the procedure

Figure 2

(a) Chest X-ray PA view of Patient 1 showing the presence of a hollow bead in the left main bronchus (highlighted by the white arrow) just distal to the carina. (b) Patient 1: After threading the Fogarty catheter through the bead, the balloon is inflated with air to lock the bead. (c) Patient 3: After threading the Fogarty catheter through the fragmented component of the ball pen, the balloon is inflated with air. (d) Patient 3: The fragmented component of the ball pen is sandwiched between the tip of the bronchoscopy sheath and the inflated balloon. Images 2B-D are trying to demonstrate the intra-bronchial events through ex vivo simulation

Figure 3

Diagrammatic depiction of the mechanics involved in grasping the smooth spherical foreign body with the jaws of the forceps. (1) Bronchial wall, (2) Bronchial mucosa with varying degrees of edema depending upon duration of foreign body and its nature (organic vs. inorganic), (3) Intra-bronchial passage, (4) Smooth, spherical foreign body; necklace bead intended to be depicted in the figure, and (5) Optical alligator foreign body forceps. (A) Direction of forceps applied by the closing jaws of the optical alligator foreign body forceps. (B) The equator of the spherical foreign body. It may be noted that the jaws will rarely reach beyong the equator. The airway is narrow and limits the permissible size of the jaws and their width. (C) The foreign slips the grasp and is displaced distally as a result of cumulative effect of the forces applied by the jaws of the forceps. The smooth surface and the spherical shape both predispose to such an event