Esophageal Coin Bougienage

1. See Also
   1. Esophageal Foreign Body
2. Indications (all must be present)
   1. Child over age 12 months AND
   2. Single coin (confirmed on Chest XRay PA and Lateral images) AND
   3. Present less than 24 hours AND
   4. No prior Esophageal Foreign Body AND
   5. No history of esophageal disease and no esophageal surgery AND
   6. Stable with no respiratory distress
3. Preparation
   1. Hurst Tip Esophageal Dilator (Esophageal Bougie)
      1. Flexible Rubber tube filled with metal (e.g. Mercury, tungsten)
      2. Age <2 years: 28 French
      3. Age 2-3 years: 32 French
      4. Age 3-4 years: 36 French
      5. Age 4-5 years: 38 French
      6. Age >5 years: 40 French
   2. Measure length of insertion
      1. Tip of nose to ear to xiphoid
      2. Use tape to mark the depth on bougie
   3. Lubricant (e.g. KY Jelly)
      1. Apply to dilator
   4. Bite Block
      1. Pre-fabricated or
      2. Tongue Blades taped together (~7 stacked)
4. Technique
   1. Pre-medication with intranasal Versed
   2. Anesthetize the posterior pharynx (e.g. atomized Lidocaine 1% via MADD Atomizer or cetacaine)
   3. Child sits in lap of parent or assistant
   4. Insert bite block or Tongue blades and depress the Tongue
   5. Insert the lubricated bougie
   6. Pass the Esophageal Bougie to the pre-measured depth
   7. Confirm on Chest XRay and Abdominal KUB that the coin has passed into the Stomach
5. Resources
   1. Pediatric Esophageal Coin Bougienage (Ben Orozco, MD)
      1. https://vimeo.com/204411132
6. Efficacy
   1. Single pass success rate approaches 95%
7. Safety
   1. Studies below are without complications of Esophageal Rupture, perforation, Hemorrhage or aspiration
8. References
   1. Allie (2014) Am J Emerg Med 32(10):1263-9 +PMID:25178851 [PubMed]
   2. Arms (2008) Ann Emerg Med 51(4):367-72 +PMID:17933426 [PubMed]