Using Occlusive Foley Catheters to Control Excessive Tumor-Related Bleeding

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Dr Harinder Singh Bedi  CMC 2014

Dr.Harinder Singh Bedi
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The lowly Foley to the rescue

It was the 4th case .

A meticulous  total arterial off pump bypass and and two hectic mitral and tricuspid valve repairs – the 2nd had required some extra  time as it was a young lad and I wanted to avoid a valve replacement at all cost . Anyway they all went well. The 4th was the Associate consultant’s case – a young lady with myasthenia gravis and a thymoma . On CT it looked well encapsulated . The Associate was an  experienced surgeon – a bit gung–ho at times (reminded me of myself !!).

I peeped in – he gave the thumbs up sign . I checked on the post op heart patients op and went into the changing room. The nurse barged in frantically – “Come fast” – was all she said . She is a veteran and not one to panic at small things . I raced in . There was 2 litres of blood on the floor and an ashen faced Associate. My anesthetist was rapidly pumping in fluid. A quick scrub and in I went . “ I just cranked open the chest and the tumour tore out the veins “ the Associate mumbled . He was shaken – but had the good sense to just put a few gauze pieces and his finger on the bleeders .

I saw that there were gaping holes in the veins ! .  The sternal retractor on opening had torn the thymic tumour which was invading all structures around it  (the CT was 6 weeks old – promised myself to always get a fresh CT before surgery ) . Packed again – hurriedly assembled an indigenous cell saver . On gently having a re-look with the cell saver salvaging all blood – saw an alarming site – totally torn off veins – + huge azygos bleeding like crazy  .

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I Put in 3 Foleys’ –

  • Right brachiocephalic (R) ,
  • Innominate (I),
  • Azygos (A) and clamped upper end of SVC ,
  • T = hard tumour .
  • Repaired with autologous pericardium. Debulked to some extent .

The case highlights a few important points :

  1. Always get a fresh CT in a malignancy
  2. Spread the retractor slowly
  3. Do not panic
  4. Think on your feet – Quick thinking by team – Dr A Joseph, DrVivek Tewarson, Dr Viju  Abraham, Cardiac Anesthetist Dr N Dua , Chief Perfusionist Mr William Prem who assembled the ‘cell saver’ (sucked into a cardiotomy reservoir and pumped it back in ) and OT incharge Mr Rajan .
  5. Think simple – the lowly Foley’s catheter saved the day . Attempting to clamp the bleeders would have been disastrous !

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