Foley Catheters as Temporary Gastrostomy Tubes

Abstract

Percutaneous endoscopic gastrostomy tube is the modality of choice for long-term enteral nutrition. In the event that replacement tubes are not available, urinary catheters can be used to maintain patency of the gastrostomy tract. This study reports our experience in a nurse-led service using Foley catheters as temporary gastrostomy tubes and the associated complications. Patients who had used Foley catheter as gastrostomy tube over a 2-year period (Jan 2011 to December 2012) were studied. Twenty-one patients had used Foley catheters as a temporary gastrostomy tube, and 12 (57.4%) did not experience any complications, including three patients who were still using Foley catheters at a median of 15 months (range 3-18). Two patients preferred the Foley catheter as feeding tubes. Six patients had replacements with formal balloon replacement tubes, and two patients did not require replacement. Complications occurred in nine (42.6%) patients: repeated burst Foley catheter balloon with peristomal leakage (n = 4), lumen blockage (n = 1), and catheter migration resulting in small bowel obstruction (n = 4). All complications were successfully managed with tube replacements. We showed that in a nurse-led service, using a Foley catheter as a temporary feeding gastrostomy tube is safe, but requires monitoring for complications.

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Therefore, if dislodgment occurs after 4 weeks from initial placement, one can consider that the tract is mature and if a replacement balloon-type tube is available on site, this can be inserted through the pre-existing tract at the patient's bedside, without recourse to endoscopic visualization. If a replacement is not available and since the mature tract will start closing within the first 24 hours from tube dislodgment, the insertion of a temporary Foley catheter, in an attempt to keep the mature tract patent has been proposed [124,125]. However, the use of Foley catheters has been associated with high complication rates [125] and the evidence to recommend their use is considered to be of low quality [126].…”

“…If a replacement is not available and since the mature tract will start closing within the first 24 hours from tube dislodgment, the insertion of a temporary Foley catheter, in an attempt to keep the mature tract patent has been proposed [124,125]. However, the use of Foley catheters has been associated with high complication rates [125] and the evidence to recommend their use is considered to be of low quality [126]. In the case that replacement tube position is uncertain, direct endoscopic verification or use of a water-soluble contrast facilitated "tubogram" should be used to confirm the position.…”

Caring for patients on home enteral nutrition: Reported complications by home carers and perspectives of community nurses

“…However, the use of percutaneous endoscopic gastrostomy (PEG) and nasogastric tubes (NGT) were the two most common enteral devices reported in the literature. Studies have shown that NGT was frequently used in patients who required short‐term ETF, whereas PEG was more commonly used among patient who required long‐term ETF (Arribas et al., ; Metussin, Sia, Bakar, & Chong, ).…”

A wandering tube

“…5 We found no relevant statistics, but a current review of published literature (PubMed since inception, using "foley catheter" AND gastrostomy) revealed 38 publications in the English language which indicate that Foley catheters were being used worldwide as temporary gastrostomy tubes and that their use for prolonged periods (median 15 months) was acceptable and cost-effective. 6 Short-term trials of Foley catheters have yielded safety data comparable to commercial gastrostomy tubes 5 , but our patient case is a reminder of the ease of a catheter being "swallowed" unless properly cared for and fixated, and the need for emergency physicians to be aware of these potential complications which may not be apparent on presentation and to also consider "wandering" tube in the differential diagnosis of obstruction or ileus in the elderly.…”