Best use for a bougie?

OK people, time to share.

Following on from befriend the bougie! @MDaware shared a great tip about using the bougie to assist in intercostal catheter placement in obese patients. Indeed, I suggested that the bougie is so fantastic, if there is a hole, it is probably worth sticking a bougie in it one time or another. Whereupon @GrahamWalker claimed that the bougie-assisted rectal examination is not to be sniffed at (he may have been joking, it can be hard to tell with Americans…).

Here are some cool pics that @GrahamWalker took in the SimLab demonstrating the use of a bougie to place an intercostal catheter. I’ve only tried this technique once in 2009, and it worked nicely. If there doesn’t seem like there is much bougie sticking out the end (e.g. an obese patient) you can shorten the intercostal catheter with scissors by trimming the end that will remain outside the patient. Don’t have a chest tube handy? You can use an endotracheal tube as a chest tube replacement (e.g. in austere environments).

bougiechesttube

Photos by Graham Walker

Which leads us to the present.

I want LITFLers to share their best, most inventive, most creative and most useful uses for a bougie. Don’t be shy, there could be an honorary Fellowship of UCEM on offer!

Leave a comment below.

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  1. says

    I love my bougie.

    Could use it as :

    -- a sound for placing Mirena (bougie-assisted contraception)
    -- a probe for exploring FBs in nasal cavity (Coude tip useful for manipulating marbles out of kids noses)
    -- urethral dilator (pUnitive technique for patients feigning unconsciousness or pseudoseizures)

    Still, it’s not all good. Remember Michael Jackson and his propofol death? I heard the paramedics said he was a difficult intubation…they ‘blamed it on the bougie/boogie’

  2. says

    Oh…just remembered two more uses…

    -- earwax removal (I love earwax…patient comes in miserable and yet within a few minutes we hose out the goop and they leave happy…even pay their bill)

    and

    -- as an adjunct to the neurological exam (like the tendon hammer, red pins and Mercedes key for plantars)

    The specific use of the bougie is to elicit the Leeuwenburg Reflex, which i discovered last week whilst bored giving a five hour anaesthetic. Whilst the surgeonswere guddling around in the abdomen, Myself and anaesthetic nurse (both bored to tears, so much so I though was going to have to put the BIS monitor on myself, not patient), played around with various bits of anaesthetic equipment.

    We discovered the Leeuwenburg reflex whilst using the bougie to remove some navel fluff.

    Specifically, the Leeuwenburg reflex is the feeling of tingling along the dorsum of the penis when the bellybutton is stimulated by a ‘swirl’ within it, using a bougie (or I suppose a biro would do)

    I do not know what this means, but it was kind of fun….

    I have indicated to my anaesthetic nurse that further research may be needed, specifically to look for the ‘reverse-Leeuwenburg reflex’ (ie: stroking the dorsum of penis and seeing if it elicits a tingling sensation in the navel) but she has demurred.

    Anyway, these are my bougie uses for submission to the UCEM….

  3. says

    Other uses suggested by my rural GP-anaesthetist colleagues on Kangaroo Island…

    -- adjunct for unblocking clogged sink/drain
    -- device for retrieving objects under sofa/behind bed etc
    -- slim jim for breaking into car if lock keys inside (although being on an island we dont often need to lock car or house)
    -- whip to round up recalcitrant sheep or animals

    Is that enough?

  4. says

    Bored fiddling led to my discovery that disposable bougies are hollow! Just snip the tips. I tried to MacGyver a method to test ETCO2 via bougie but could not get it to work. Best idea was to tape a 15mm ETT adaptor to the end, then ETCO2 adaptor, then esophageal detector device (big syringe that fits on ETT) to suck out air. Didn’t seem to work on healthy controls (my and Reuben Strayer’s oropharynxes)

  5. says

    Chris

    Excellent movie reference…if I had been drinking a milkshake it would have come out of my nose

    Extremely obvious but not mentioned I don’t think- swizzle stick for stirring alcoholic beverages

    A medium for modern art? I’m picturing a LITFL logo made of variously colored bougies

  6. says

    Snip both ends off a ventilating bougie, retire to a Texas book depository equivalent upper floor of your hospital with a bag of puy lentils and pick off walk-in patients as they arrive to ED. Beware s second pea shooter on the grassy knoll where the smokers gather…

  7. Jake Barlow says

    Bit late, but I think it would be the only way to place an IDC in Scott “20 inches” Weingart.

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