Management of feeding-Foley-catheter complications typically involves deflation of the balloon and removal and replacement of the offending catheter—usually with a smaller sized Foley catheter (eg, 12Fr, 14Fr, 16Fr). Complicated cases with catheter malfunction have been successfully managed endoscopically.14 The patient in this case was likely at higher risk of complication given the abnormally large wound surrounding the stoma and skin breakdown secondary to superimposed infection.
Conclusion
This case highlights the potent peristaltic forces that are exerted upon a feeding Foley catheter and reinforces the importance of proper tube anchorage. Although this patient did well with direct skin suturing of the replacement catheter, previous studies recommend using a plastic retention ring. Placing a mark on the outside of the catheter as a means to continuously visualize its proper anchorage and placement has also been suggested in the literature. Additionally, whenever a patient presents with a displaced feeding tube (Foley catheter or commercial tube), providers should not assume that the tube has been displaced externally and should maintain a low-threshold for advanced imaging and/or endoscopy if the tube cannot otherwise be located.
Dr Lefkove is an attending physician in the department of emergency medicine, DeKalb Medical Center, Atlanta, Georgia. Dr Meloy is an assistant professor of emergency medicine at Emory University School of Medicine, Atlanta, Georgia.