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Esophageal Coin Bougienage
Aka: Esophageal Coin Bougienage, Esophageal Bougie
- See Also
- Esophageal Foreign Body
- 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
- Preparation
- Hurst Tip Esophageal Dilator (Esophageal Bougie)
- Flexible Rubber tube filled with metal (e.g. Mercury, tungsten)
- Age <2 years: 28 French
- Age 2-3 years: 32 French
- Age 3-4 years: 36 French
- Age 4-5 years: 38 French
- Age >5 years: 40 French
- 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)
- 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
- Resources
- Pediatric Esophageal Coin Bougienage (Ben Orozco, MD)
- https://vimeo.com/204411132
- Efficacy
- Single pass success rate approaches 95%
- Safety
- Studies below are without complications of Esophageal Rupture, perforation, Hemorrhage or aspiration
- References
- Allie (2014) Am J Emerg Med 32(10):1263-9 +PMID:25178851 [PubMed]
- Arms (2008) Ann Emerg Med 51(4):367-72 +PMID:17933426 [PubMed]