II. Indications (all must be present)
- Child over age 12 months AND
- Single coin (confirmed on Chest XRay PA and Lateral images) AND
- Present less than 24 hours AND
- No prior Esophageal Foreign Body AND
- No history of esophageal disease and no esophageal surgery AND
- Stable with no respiratory distress
III. Preparation
- Hurst Tip Esophageal Dilator (Esophageal Bougie)
- Measure length of insertion
- Tip of nose to ear to xiphoid
- Use tape to mark the depth on bougie
- Lubricant (e.g. KY Jelly)
- Apply to dilator
- Bite Block
- Pre-fabricated or
- Tongue Blades taped together (~7 stacked)
IV. Technique
- Pre-medication with intranasal Versed
- Anesthetize the posterior pharynx (e.g. atomized Lidocaine 1% via MADD Atomizer or cetacaine)
- Child sits in lap of parent or assistant
- Insert bite block or Tongue blades and depress the Tongue
- Insert the lubricated bougie
- Pass the Esophageal Bougie to the pre-measured depth
- Confirm on Chest XRay and Abdominal KUB that the coin has passed into the Stomach
V. Resources
- Pediatric Esophageal Coin Bougienage (Ben Orozco, MD)
VI. Efficacy
- Single pass success rate approaches 95%
VII. Safety
- Studies below are without complications of Esophageal Rupture, perforation, Hemorrhage or aspiration