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Pediatric Pearls: Kids with Hardware

Ilene Claudius, MD and Solomon Behar, MD
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EM:RAP October 2013 Written Summary 2 MB - PDF

Kids with G-tubes, J-tubes are popping up in our ED's more and more and they mostly they are not life threatening. But the kids with trach issues is a much different situation. Sol and Ilene share the key points in treatment.

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New Kid, MD -

Great talk! The day after listening, I had a very annoyed mom bring in her child for 2 months of G-tube leakage causing erythema around the site (likely due to acidic irritation). I inflated the balloon from 3 to 4cc and she tolerated it well. I took lots of talking points from Sol's discussion to relay a plan to mom.

Drew G., M.D. -

Nice talk - thanks! One fine quibble with Mel's comment on Coca-Cola. Dissolving thing with Coke is an old urban myth. It just won't work. Nice reference to an actual experiment and a "snopes" reference.
http://joshmadison.com/2003/12/14/will-coke-dissolve-a-nail-experiment/
http://www.snopes.com/cokelore/tooth.asp

Does it really work with a g-tube? No references in the entire EMA database. The bubbles of carbonation may help but that is pretty unlikely.

ilene c. -

I must agree with that article. In 3rd grade, a friend of mine (for his science project) put a tooth in a can of coke for a week. The tooth was brownish, but intact when he removed it. While I'll concede that cola won't remove a tooth from a g-tube, I am impressed with how well it seems to unclog other stuff (hey, let's do a study!). The nurses at CHLA have strong feelings on whether it has to be Coke or any dark soda or any soda, sugar, sugar-free, etc. I've never tried much outside of regular coke, but there were so many differing opinions, I suspect they are all OK.

Ralph D., MD -

day,ralph
I really don't know if I should be doing this but I don't believe it would mess up the G tube product integrity--I insert the wood end of a Q tip into the G-tube to give it some stiffness or you can use the other end of a culture swab which at our ED is flexible and plastic. Anyway I find with a lubed up G tube--I really can't push it directionally--too floppy. Anyone see a problem with this?

joseph A. -

An even quicker (5 second) clogged j-tube fix.
1) fill one (or two if there is a side port) 1ml or 3ml cathtip syringe (smaller=greater force per surface area). Don't make the mistake of using a big syringe. In this case smaller is better.
2) push the water in the j-tube. Your greatest challenge will be holding the syringe up to the j-tube port(s) with a tight enough seal such that the water goes in the tube instead of back up into your face making you look so smooth. If there are two ports, this is a two person job.

I usually have the parents help so that they see they can do this at home and spare themselves the long ride to the hospital at 2am.

This has worked when coke etc have not and spares the VERY EXPENSIVE j-tube replacement

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Episode 145 Full episode audio for MD edition 218:18 min - 103 MB - M4AEM:RAP Resumen October 2013 Español 97:28 min - 67 MB - MP3EM:RAP 2013 October MP3 266 MB - ZIPEM:RAP October 2013 Written Summary 2 MB - PDFEM:RAP October 2013 Board Review Questions 641 KB - PDFEM:RAP October 2013 Board Review Answers 658 KB - PDF

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