Foreign Body Ingestion Clinical Pathway — Emergency Department, ICU, and Inpatient

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Related Pathway

Behavioral Health Issues, ED

Suspected Foreign Body Ingestion

Guidance for Referred Patients

Patients transferred for confirmed
- Esophageal, nasal or airway Button Battery
Activate Button Battery Notification
- Cluster notification to ENT, GI, Gen Surgery and OR to prepare for patient
- Patient goes directly to OR
Pre-hospital recommendations
National Capital Poison Center
Button Battery Ingestion Triage and Treatment Guideline
National Battery Ingestion Hotline:
800-498-8666

IMAGING
AP single view (chest, neck, abdomen)
Lateral if: Battery/magnet suspected Esophageal location
FB location uncertain
All coins

Triage, Imaging

Resuscitation Room:
Impending/Existing
Respiratory or
Circulatory Failure

Suspect ingested
or nasal button battery
Notify PEM and expedite X-ray

MD/CRNP/RN Rapid Assessment
History and Physical, Imaging

Button Batteries
Confirmed esophageal button battery Activate Button Battery Notification

Coins/
Blunt Objects

Magnets

Single
Multiple

Sharp Objects

Radiopaque or Suspected Radiotranslucent

Non-Radiopaque/
Special Circumstances

Food Impaction

Other Foreign
Bodies

GENERAL TIMING OF ENDOSCOPY
Emergent (ASAP)	Urgent (< 24 Hours)	Non-Urgent (> 24 Hours)
Esophageal Location BUTTON BATTERY – NO DELAY Obstructive symptoms Respiratory distress Significant pain Sharp pointed objects Multiple magnets Stomach Location Multiple magnets	Esophageal Location Minimal symptoms Sharp longer objects in stomach with no symptoms	Stomach Location FB ≥ 2 cm wide and ≥ 5 cm long

IMPORTANT PHONE NUMBERS
Operating Room 5-4444
Poison Control Center (PCC) 4-2100 or 800-222-1222
National Battery Ingestion Hotline 800-498-8666

Posted: July 2013
Revised: January 2016, August 2016, September 2018, November 2018, October 2020
Authors: P. Mamula, MD, S. Sobol, MD, C. Ford, MD

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Emergency Department Clinical Pathway for the Evaluation/Treatment of Children with Foreign Body Ingestion

Evidence