Need to pick your brains...

  1. As there are so many brilliant minds here at allnurses, I need to ask you all a question. Can you perform the Heimlich on a person with a fundal plication?? My home health care client has a fundal plication, and mom says if he were ever to choke, the Heimlich can't be done on him, just back blows. Is this true? Help me with this as my client is 2 and a half years old, and LOVES to put everything in his mouth. Believe me I am EXTRA vigilant with him. Thanks.
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  2. 5 Comments

  3. by   warrior woman
    He's a real sweet kid too. Gave me a kiss before I left yesterday.
  4. by   Brownms46
    I bet he is a cutey WR!. If the child has a complete closure of the opening from the esophagus to the abdomen, then the abdominal thrusts would probably not be effective. Sometimes they only do a partial closure if GERD was the problem. Does he have a GT?? Why did he have the Nissen done??
  5. by   canoehead
    If the obstruction is in the airway you are depending on forced air from the lungs to get the obstruction up, so a closure between the esopagus and stomach is irrelevant.
  6. by   Brownms46
    Let me try this again. Nissen Fundoplication is a procedure that creates a one-way valve in the esophagus, to allow food to pass into the stomach, but prevent stomach acids from going into the esophagus and thus prevent GERD.

    However many pts. who have had this surgery, have complications, and some of them are bloating, continued reflux (d/t wrap being too loose), or vomiting. Therefore it maybe the reason the mother states that abdominal thrusts can't be done, as it would be not only possibility ineffective, but risky. As many of these pts., and prone to aspiration. Some pts. even develop swallowing problems after the procedure is done, and is the reason I asked did the child have a GT.

    Even though many pt. get them remioved a few months after the procedure, some don't d/t the problems with swallowing. Heck some folks even have to have the procedure done again, or some docs only do a partial warp. There are different beliefs and studies about this procedure, and some docs advise against having it done. For some it brings more problems then relief!

    I always thought that the air from the abd, and the abd muscles were part of the process that helped you to cough. That force of the upward thrust also pushed air from the abd, creating the pressure that helps force out the obstruction. I maybe wrong, but that was my thinking.

    The Heimlich is done at the top of the abd, where the warp has been done, another risk in my mind. Great question! I have been working at a GI clinic, so I find this very interesting!
  7. by   warrior woman
    Thanks Brownie!! He was born a drug baby, and may have had a stroke in utero. The doc's say that he woud never walk or even crawl, but he now runs circles around everybody in the house!! He has a g-tube, but can eat soft foods orally and only goes on the feeding pump for a few hours a night. He's making so much progress. I totally love working for this family. The mom adopted him and 8 other kids rescuing them from abusive situations. They are all the sweetest most well adjusted kids. The younger ones go to preschool, and the older ones are homeschooled. I wish I could work more that the 2 8 hour shifts I do, but she is only allotted 2/ 8 hour shifts during the week and a few hours during the weekend. Never thought I'd love homecare, but I do. Especially this assignment. These folks have already taught me a lot about heart and compassion.

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