Keywords
neck injury
foley catheter
balloon occlusion
bleeding control
observation
SNOM
How to Cite
Abstract
Introduction: The incidence of penetrating neck injuries is experiencing an upward trend. Given that hemorrhaging stands as one of the most preventable causes of fatality in traumatic situations, the prospect of employing a foley catheter (FC) to manage bleeding following penetrating neck injuries has led to contemplation on its integration into standardized protocols for bleeding control (BC), both in prehospital and in-hospital settings. Furthermore, inquiries into establishing standardized schedules for its application have arisen.
Material and Methods: A meticulous search strategy was conducted utilizing the NCBI Medical Subject Heading (MeSH) term "foley*" and various combinations such as "foley" AND "trauma"; "foley" AND "neck"; "foley" AND "penetrating"; "catheter" AND "balloon" AND "trauma"; "gunshot" AND "neck"; "hemorrhage*" AND "neck" across multiple databases. These databases include MEDLINE, PubMed, PubMed Central, Scopus, Ovid, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Additionally, comprehensive searches using these terms were performed on Google, Google Scholar, and ResearchGate. The references cited in documents retrieved from these searches, covering 1833 to 2023, were thoroughly scrutinized.
Results: 15 relevant articles were identified, and pertinent data were extracted from these studies. Historically, the use of FC was confined to immediate bleeding control; however, it has now extended its application into prehospital, emergency room (ER), and intraoperative settings. The primary success rate of FC stands at n=229 out of 274 cases (84%). FC serves as a valuable tool to bridge the gap in time before reaching the ER or operating room (OR), facilitating necessary radiological studies or interventions, especially when more severe injuries necessitate prioritization. Typically, FC was retained for 24-48 hours, but instances of prolonged applications up to 240 hours have been documented. Notably, it includes the definitive management of venous neck bleeding injuries, contingent upon excluding significant arterial defects through CTA. Late rebleeding stands at a low rate of 6% (14 out of 229 cases).
Conclusion: Using FC is a pertinent strategy in managing neck injuries resulting from bleeding from penetrating wounds. Its substantial primary success rate in prehospital and ER phases surpasses the success rates achieved solely through pressure or chitosan dressing. Post-primary bleeding control, the presence of FC facilitates examinations and radiological interventions. Determining the optimal duration for FC placement remains a subject for consideration, leaning toward 2-3 days, if not longer. FC is progressively solidifying its role in Selective Non-Operative Management (SNOM) for hemorrhagic penetrating neck injuries. Consequently, a Foley catheter should be an essential tool in the possession of every prehospital and ER physician. Further delineation of criteria establishing the suitability of FC placement as definitive SNOM therapy for hemorrhagic penetrating neck injuries warrants consolidation.
References
Associaton WM. WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. 1964. http://www.wma.net/en/30publications/10policies/b3/.
Hawkins A, Ponnusamy S, Markiewicz MR, Callahan N. Use of a Foley catheter to drainage deep space neck infections. Br J Oral Maxillofac Surg 2019; 57(9): 942-3.
Kishev SV. Examination of stenotic bladder neck using the Kishev balloon stretch test with the Foley catheter (author's transl)]. Urologe A 1978; 17(3): 190-3.
Sindeeva OA, Abdurashitov AS, Proshin PI, et al. Ultrasound-Triggerable Coatings for Foley Catheter Balloons for Local Release of Anti-Inflammatory Drugs during Bladder Neck Dilation. Pharmaceutics 2022; 14(10).
Smellie GD. Control of post-haemorrhoidectomy bleeding with a Foley catheter and a pack. J R Coll Surg Edinb 1965; 11(4): 328.
Aungst M, Wagner M. Foley balloon to tamponade bleeding in the retropubic space. Obstet Gynecol 2003; 102(5 Pt 1): 1037-8.
Duckett JR, Tamilselvi A, Jain S. Foley catheter tamponade of bleeding in the cave of Retzius after a Tension Free Vaginal Tape procedure. J Obstet Gynaecol 2005; 25(1): 80-1.
Rezk M, Saleh S, Shaheen A, Fakhry T. Uterine packing versus Foley's catheter for the treatment of postpartum hemorrhage secondary to bleeding tendency in low-resource setting: A four-year observational study. J Matern Fetal Neonatal Med 2017; 30(22): 2747-51.
Yared G, Tachdjian A, El Kazwini MEJ, Azzi J, El Hajjar C, Ghazal K. A case study on using an intrauterine foley catheter to reduce postpartum bleeding in a patient with hemophilia. Int J Gynaecol Obstet 2023.
Atilgan R, Aslan K, Can B, Sapmaz E. Successful management of pelvic bleeding after caesarean hysterectomy by means of Foley catheter-condom balloon tamponade. BMJ Case Rep 2014; 2014.
Lu YM, Guo YR, Zhou MY, Wang Y. Indwelling Intrauterine Foley Balloon Catheter for Intraoperative and Postoperative Bleeding in Cesarean Scar Pregnancy. J Minim Invasive Gynecol 2020; 27(1): 94-9.
Timor-Tritsch IE, Cali G, Monteagudo A, et al. Foley balloon catheter to prevent or manage bleeding during treatment for cervical and Cesarean scar pregnancy. Ultrasound Obstet Gynecol 2015; 46(1): 118-23.
Vlahos NP, Bankowski BJ, Makrakis E. Non-puerperal uterine rupture after use of misoprostol and a Foley catheter for management of uterine bleeding. Int J Gynaecol Obstet 2005; 88(3): 331-2.
Priego-Jimenez P, Ruiz-Tovar J, Paiva-Coronel GA. [Use of Foley's catheter to control abdominal wall bleeding in the trocar insertion place during laparoscopic surgery]. Rev Gastroenterol Peru 2011; 31(3): 241-4.
Ruiz-Tovar J, Priego-Jimenez P, Paiva-Coronel GA. Use of Foley's catheter to control port-site bleeding in bariatric surgery. Obes Surg 2012; 22(2): 306-8.
Pearce CW, McCool E, Schmidt FE. Control of bleeding from cardiovascular wounds: balloon catheter tamponade. Ann Surg 1966; 163(2): 257-9.
Wheeler RT, Kovacic JP. The use of a Foley balloon catheter to control junctional hemorrhage in a dog with severe vascular injury secondary to penetrating trauma. J Vet Emerg Crit Care (San Antonio) 2022; 32(1): 119-24.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Internat J Surg 2021; 88: 105906.
Navsaria P, Thoma M, Nicol A. Foley catheter balloon tamponade for life-threatening hemorrhage in penetrating neck trauma. World J Surg 2006; 30(7): 1265-8.
Weppner J. Improved mortality from penetrating neck and maxillofacial trauma using Foley catheter balloon tamponade in combat. J Trauma Acute Care Surg 2013; 75(2): 220-4.
Degiannis E, Bonanno F, Titius W, Smith M, Doll D. [Treatment of penetrating injuries of neck, chest and extremities]. Chirurg 2005; 76(10): 945-58.
Eastridge BJ, Hardin M, Cantrell J, et al. Died of wounds on the battlefield: causation and implications for improving combat casualty care. J Trauma 2011; 71(1 Suppl): S4-8.
Holcomb JB, McMullin NR, Pearse L, et al. Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001-2004. Ann Surg 2007; 245(6): 986-91.
Shuker ST. The immediate lifesaving management of maxillofacial, life-threatening haemorrhages due to IED and/or shrapnel injuries: "when hazard is in hesitation, not in the action". J Craniomaxillofac Surg 2012; 40(6): 534-40.
Madiba TE, Muckart DJ. Penetrating injuries to the cervical oesophagus: is routine exploration mandatory? Ann R Coll Surg Engl 2003; 85(3): 162-6.
Ngakane H, Muckart DJ, Luvuno FM. Penetrating visceral injuries of the neck: results of a conservative management policy. Br J Surg 1990; 77(8): 908-10.
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