Interprofessional collaboration

BBI clinical scenarios often require prompt and efficient collaboration between various healthcare professionals in order to achieve optimal care and outcomes. In the video above, members of the surgical, ENT and anaesthesia teams provide a first impression of the diverse specialties needed to treat BBI patients effectively.

In the text below, we provide further detail on how each team is involved in the treatment pathway.

It is imperative to have agreed protocols with anaesthesia colleagues for BBI in the oesophagus to have emergency endoscopic removal within 2 hours regardless of fasting time and with rapid sequence induction, especially for cases presenting with active or sentinel haemorrhage. Recent case series have reported usage of video laryngoscope for the removal of foreign bodies in the upper oesophagus.

If the ingested battery is located in the airway or in the gastrointestinal tract above the clavicles, an ENT doctor should be consulted to remove objects from the upper airways or upper part of the oesophagus by rigid endoscopy. In some cases, it is necessary to perform the endoscopic procedures in collaboration with, for example, a paediatric gastroenterologist. The most typical paradigm of such a scenario is tracheoesophageal fistula, secondary to a retained aerodigestive BB, a devastating development. Management is challenging, and the clinical timeline of watchful waiting versus surgical intervention for tracheoesophageal fistula is poorly defined in the literature. Data from a 2022 systematic review by Poupore et al. suggests that if clinical status permits, a period of observation of at least 8 weeks before surgical intervention may be practical for many BB-induced tracheoesophageal fistulas.

In some cases, it is very difficult to extract impacted upper oesophageal BBs with endoscopic forceps. In this situation, collaboration with ENT and/or anaesthesia can be sought to remove the battery with Magill forceps.

Most batteries that pass the pylorus are easily expelled. However, a small proportion may lodge in the small bowel, typically in a Meckel’s diverticulum. Children with a history of battery ingestion who present with abdominal symptoms also require surgical referral. If a battery and magnet have already passed the stomach, consultation with a surgeon is necessary; the patient should be either monitored closely or the battery and magnet should be removed surgically.

In cases of severe mucosal injury, delayed diagnosis or severe symptoms indicative of complications (such as bleeding), the cardiothoracic surgeon should be consulted and further imaging with CT scans should be performed even before the removal, as moving the battery might lead to acute perforation or haemorrhage through a fistula. In these cases, a joint approach with cardiothoracic surgeons and a cardiac catheter lab may be necessary.

Endoscopic removal of the foreign body in the cardiac catheterisation laboratory operation room with fluoroscopic guidance and arteriogram of the aorta allows direct visualisation of the BB and its proximity to the aorta.

Now, over to you!

Which other healthcare professionals do you interact with most when treating BBI cases? What benefits do you think there are to effective interprofessional collaboration, and are there any common barriers to this?

When you are ready, the next 3 steps provide an opportunity to apply your learning to a real-life clinical scenario. Make sure to share your thoughts and interact with your peers!