Pedi GI Handbook
BRAVO CAPSULE PLACEMENT:
Confirm with RN that device is calibrated
Patient in left lateral decub position
Connect vacuum tubing to delivery device
Perform vacuum pump check to verify gauge reaches 700 mmHg.
Perform EGD. Identify the GE junction. Remove the endoscope by 6 cm and note distances from incisors. Capsule will be placed 6 cm proximal to the GEJ.
With either direct endoscopic guidance or blind, deploy the capsule
Insert capsule through the mouth to 6 cm proximal to GEJ
Apply suction to the catheter until 700 mmHg is reached for 60 seconds.
Depress plunger to advance pin.
Release capsule by rotating the plunger clockwise.
If done blind, repeat scope to confirm placement.
Begin pH recording.
Ref: Sofi et al Clin Exp Gastroenterol. 2010;3:147-51. PMID: 21694859
PPI strength relative to Omeprazole
-CBC, LFTs, BMP (BUN), PT/INR, type and screen
-IV PPI 2 mg/kg bolus then 2 mg/kg divided twice daily
-IV PPI drip (2 mg/kg bolus max 80 mg, followed by 0.2 mg/kg/h max 8 mg/h)
-Fluid resuscitation (gentle!)
-Transfuse 15 mL/kg up to 2 units
-Consider vitamin K, FFP
-Consider octreotide drip: 1-2 mcg/kg bolus then start 1-2 mics per kilo per hour (max 50-100 mcg/hr)
-Consider IV erythromycin to empty stomach