From: Maureen McCollough [SMTP:[log in to unmask]]
1. How many out there are using foley catheters to remove a FB
child's esophagus?? Any bad experiences?? The literature says
easy and pretty safe if you follow the same procedure every time
down, no sedation,etc). We either do it this way or ship the
kid to another
2. Anybody have any experience with any disposable crich trays
children?? There is one called PEDIA-TRACH that looks like it
could cause a
lot of damage. COOK just came out with a disposable one for kids
and one for
adults. Supposed to be easy to use. Next question - anybody
ever done a
crich on a kid??
1. These methods are good for smooth FB like coins that have been
there for less than 24 hours and the patient has no respiratory
distress. Also, as stated in the discussion it has been successfully
used in the literature for single coins in a patient without any prior
esophageal surgery or strictures.
My boss, who was part of the Milwaukee group that first reported success
with bougienage, has been using the bougienage to push these coins down
with excellent success rates. A Hurst bougienage catheter is passed
orally with lubrication while the toddler is held. The key is to pass it
with controlled pressure and stop if there is unusual resistance. This
is a judgement call in experienced hands. The risk of perforation does
exist with this procedure as with the Foley catheter. The costs for the
patient are so much better with this; $ 3000 for an endoscopic removal
versus $ 600-700 for bougienage!!!
The surgeons in our hospital use the Foley method routinely for high
coins. They usually try a couple of times before doing endoscopy. The
bigger risk here is aspiration of the coin during removal.
2. Cook has many over the needle disposable cric kits. The one I am
familiar with is the Melker cricotyrotomy kit. Smallest size is 3.5.
Secured much like a tracheostomy tube. These are supposed to be better
than the 14-16 G angiocaths for needle crics because they are stiffer
and easier to secure. The insertion is over a wire by seldinger
technique with a self dilating tip. In a
trauma situation, that you are describing, because of C- spine concerns,
Cook does not recommend it. This is because good neck extension is
needed for adequate insertion.
I have had to do one needle cric in my career, on a 15 month old who had
aspirated a grape and was brought in asystolic by the EMT's. It was too
far below the cords to get out with a magills. I used a 16 G angiocath
and hooked it up to a jet insufflator (which I think every ED taking
care of kids should have) .Eventually, we managed to push it down with a
stylet and ETT. We did get a perfusing rhythm back but the child had
profound HIE and died in the PICU.
I would not recommend an emergent surgical cricothyrotomy if they are
less than 8 years. ATLS actually does not recommend it below 12 years.
Needle cric with jet insufflation is less messier and technically easier
( it's all relative you know!!!) while your help arrives for a
hope that helps
[Jay Pershad, M.D.]
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