Skip to main content

The use of Foley catheter tamponade for bleeding control in penetrating injuries

Dear Editor,

With great interest, we have read the review article of Simpson et al. [1] on the current evidence and recommendations for the pre-hospital management of penetrating neck injuries (PNI). We would like to comment on the use of Foley catheters to achieve bleeding control from non-compressible penetrating injuries.

In their scoping review, the authors appropriately focus on the application of haemostatic dressings to achieve external bleeding control, but they also suggest to consider Foley catheters as an additional measure to manage bleeding from PNI. Their review process identified a single case series describing the use of Foley catheters in 11 military patients [2]. Some important additional references should be cited to support the use of this adjunct. A recent article by Himmler et al. described the use of this technique in 29 civilian patients actively bleeding from penetrating torso trauma in a single major urban centre in South America [3]. The 24-h mortality was 3.4% and the 30-day mortality was 17.9%. Moreover, in 2020 Scriba et al. described a cohort of 95 patients with PNI in a South-African level I trauma centre, treated with Foley catheters [4]. Bleeding control with haemodynamic stabilisation was achieved in 92 patients (96.8%).

We recently used a Foley catheter to manage a stab wound to the left anterior neck (zone 1) in a 26 year-old male. Police arrived shortly after the incident but couldn’t stop the bleeding with external compression with gauzes. After the arrival of the pre-hospital emergency physician, a 16 French Foley catheter was inserted into the wound and the balloon was inflated with 20 ml of saline solution (Figs. 1 and 2), allowing the bleeding to stop immediately. Definitive surgical management revealed a 4–5 cm zone 1 neck wound, with injuries to the anterior jugular veins.

Fig. 1
figure 1

Foley catheter inserted into zone 1 wound

Fig. 2
figure 2

Cervical computed tomography scan with Foley catheter inflated

External bleeding control is a well-known challenge for both pre-hospital and hospital teams, as illustrated by the military c-ABC approach of trauma patients [5]. The main conclusion of the scoping review conducted by Simpson et al. is that the currently available evidence pertaining to the prehospital management of PNI is scarce, and essentially based on observational data with low sample sizes. While we agree with the authors that a consensus on the pre-hospital management of bleeding from non-compressible penetrating injuries is needed, we suggest that Foley catheter balloon tamponade should be emphasized as a valuable option.

Response to letter entitled ‘The use of Foley catheter tamponade for bleeding control in penetrating injuries’

Dear Editor,

I would like to thank Dr. Beysard and colleagues for bringing these other two published examples of Foley catheter balloon tamponade use to our attention, along with their recent use of this method. We would welcome their experience and input as part of the proposed Delphi project, along with that of all clinicians with experience managing these injuries. Through combined experience and literature assimilation we hope to generate the most clinically valuable consensus statement possible.

Availability of data and materials

Not applicable.

Abbreviations

PNI:

Penetrating neck injuries

References

  1. 1.

    Simpson C, Tucker H, Hudson A. Pre-hospital management of penetrating neck injuries: a scoping review of current evidence and guidance. Scand J Trauma Resusc Emerg Med. 2021. https://doi.org/10.1186/s13049021009494.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Jose A, Arya S, Nagori S, Thukral H. Management of life-threatening haemorrhage from maxillofacial firearm injuries using Foley catheter balloon tamponade. Craniomaxillofac Trauma Reconstr. 2019;12:301–4.

    Article  Google Scholar 

  3. 3.

    Himmler A, Calzetta ILM, Potes A, Puyana JC, Barillaro GF. The use of a urinary balloon catheter to control haemorrhage from penetrating torso trauma: a single-center experience at a major inner-city hospital trauma center. Am Surg. 2021;87:543–8.

    Article  Google Scholar 

  4. 4.

    Scriba M, McPherson D, Edu S, Nicol A, Navsaria P. An update on Foley catheter balloon tamponade for penetrating neck injuries. World J Surg. 2020. https://doi.org/10.1007/s0026802005497z.

    Article  PubMed  Google Scholar 

  5. 5.

    Hodgetts TJ, Mahoney PF, Russel MQ, Byers M. ABC to <C>ABC: redefining the military trauma paradigm. Emerg Med J. 2006;23:745–6.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

None.

Funding

There is no source of funding for this manuscript.

Author information

Affiliations

Authors

Contributions

MP, NB, and VD designed the project and drafted the work. NB obtained the written consent from the patient. MP, NB, PNC, TZ and VD revised final work. All authors approved the final version of the manuscript.

Corresponding authors

Correspondence to Vincent Darioli or Christopher Simpson.

Ethics declarations

Ethical consent and consent to participate

Not applicable.

Consent for publication

Consent form was obtained from the patient whose case and picture are discussed in the present manuscript.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Beysard, N., Pasquier, M., Zingg, T. et al. The use of Foley catheter tamponade for bleeding control in penetrating injuries. Scand J Trauma Resusc Emerg Med 29, 165 (2021). https://doi.org/10.1186/s13049-021-00975-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13049-021-00975-2