5.
INGESTED FOREIGN BODIES
Guidance
Version
1
Name of responsible (ratifying) committee
Patient Safety Steering Group
Date ratified
19 March 2015
Document Manager (job title)
Head of Nursing Emergency Department
Date issued
05 June 2015
Review date
31 March 2018
Electronic location
Clinical Guidelines
Related Procedural Documents
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Key Words (to aid with searching)
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Version Tracking
Version
Date Ratified
1
19/03/2015
Brief Summary of Changes
Author
New Guidance
T. Enticknap-Green
Ingested Foreign Bodies Guidance
Version: 1
Issue Date: 05 June 2015
Review Date: 31 March 2018 (unless requirements change)
Page 1 of 4
5.6 SWALLOWED FOREIGN BODIES (FB)
A.
B.
C.
D.
BACKGROUND
NON-HAZARDOUS SWALLOWED FOREIGN BODIES
HAZARDOUS SWALLOWED FOREIGN BODIES
INGESTION OF BUTTON BATTERIES
A. BACKGROUND
Ingested foreign bodies rarely cause problems. However when problems do occur it can be life threatening
e.g. oesophageal rupture, aorto-oesophageal fistula, tracheo-oesophageal fistula. The following guidelines
have been developed following multi-disciplinary consensus agreement based on current best-practice.
B. NON-HAZARDOUS, SWALLOWED FOREIGN BODIES
Non-metallic and non-hazardous
objects. Eating OK.
Metallic, non-hazardous object
Metal detector
Negative OR positive and below xiphisternum
level. Eating OK.
Equivocal OR
positive and above xiphisternum level
AP CXR. If not seen or if symptoms dictate, consider AXR and / or lateral soft tissue XR of neck
Seen below upper 1/3 oesophagus
ie. below level of clavicle
Seen in upper 1/3 oesophagus OR
not seen but likely to be a
radiolucent FB
Eat and drink plus repeat metal detector
Detected below xiphisternum level
Reassure but DO NOT instruct parents
to inspect faeces for FB. Clinical /
radiological review only if symptomatic
Still detected above
xiphisternum level
Refer to Paediatric surgeon not
ENT
Consider foley balloon catheter removal
(especially for coins)
Admit for endoscopy under GA
Ingested Foreign Bodies Guidance
Version: 1
Issue Date: 05 June 2015
Review Date: 31 March 2018 (unless requirements change)
Page 2 of 4
5.6 SWALLOWED FOREIGN BODIES (FB)
C. HAZARDOUS, SWALLOWED FOREIGN BODIES
Hazardous = sharp object, very large object, button battery or filled balloons
Hazardous foreign body
AP CXR. If not seen or if symptoms
dictate, consider AXR and / or lateral soft
tissue XR of neck
Oesophagus
Stomach
Refer to paediatric surgeons (not
ENT)
Eat / drink. Repeat XR after
12 hours.
Not moved
Urgent surgical referral
Out of
stomach
Discharge
Additional Points:
- If history of coughing or choking, consider inhalation of foreign body (see sections 3.27 & 5.7).
- If there is evidence of complications, films should be requested.
- A metal detector will pick up aluminium, e.g. can ring-pulls, which may not be seen on an X-ray.
D. INGESTION OF BUTTON BATTERIES
Background
These batteries can be dangerous if ingested as the seal on them is dissolved by gastric acid and the
contents are toxic. There is also a danger of local erosion of the mucosa by current passing from the battery, if
the battery is a fresh one. If possible obtain the battery details from the packet of another battery of the same
sort and contact the poisons centre via toxbase for more up to date information.
Management
- All children who have swallowed a battery should have an X-ray of the chest (and abdomen if not visible
on CXR) to locate the battery as soon as possible. A metal detector is unreliable, as some batteries
cannot be detected by the use of a metal detector.
- If the battery is in the oesophagus, urgent referral to the Paediatric Surgeons is needed.
(continued)
Ingested Foreign Bodies Guidance
Version: 1
Issue Date: 05 June 2015
Review Date: 31 March 2018 (unless requirements change)
Page 3 of 4
5.6 SWALLOWED FOREIGN BODIES (FB)
D. INGESTION OF BUTTON BATTERIES
-
-
Management (continued)
If the battery is below the diaphragm, the child can eat and drink normally. Repeat the AXR after 12 hours,
or as soon after this time in order to be done in daylight hours. The child can go home between films,
providing the parents are instructed to bring the child in sooner if any abdominal symptoms develop.
If the battery has not moved on the second X-ray, refer to the surgeons urgently. The battery may have
become adherent to the gastric mucosa, leading to a high risk of erosion.
If the battery has moved position below the diaphragm and is not fragmenting (i.e. out of the stomach) the
patient can be safely discharged.
Do not instruct parents to “look for FB in the stools”.
If in doubt at any stage, discuss with the surgical registrar.
References:
- Things that go beep: Compliance with an ED guideline for use of a handheld metal detector in the
management of non-hazardous metallic foreign bodies, adverse outcomes and a suggested improvement
to the guideline.
- S Ramlakhan, J Gilchrist, D Burke. Accepted for publication EMH April 2006.
- Metallic Foreign Bodies - Protocol for the use of the Metal Detector. Sheffield Children’s Hospital X-ray
Dept. Protocol. Dr. P. Broadley.
- The use of a metal detector to locate ingested metallic foreign bodies in children. B Tidey et al. J Accid
Emerg Med 1996:13:341-2.
- Using a metal detector to locate a swallowed ring pull. J Ryan et al. J Acid Emerg Med 1995:12:64-5.
Ingested Foreign Bodies Guidance
Version: 1
Issue Date: 05 June 2015
Review Date: 31 March 2018 (unless requirements change)
Page 4 of 4