Nasal Foreign Body Removal

imagesPresence of foreign material within the nostril


CONTRAINDICATIONS



imagesIf the foreign body entered the nose traumatically and there is concern it has penetrated the cranial cavity


imagesIf there is danger of obstructing the airway



imagesGeneral Basic Steps


   imagesPatient preparation


   imagesAnesthesia


   imagesChoose method of removal


TECHNIQUE



imagesPatient Preparation


   imagesAn uncooperative child should be properly immobilized or sedated


      imagesAn option is to papoose the child in a blanket in the supine position with the arms at the sides and an assistant holding the head still


   imagesUsing a syringe as a dropper, instill either lidocaine and phenylephrine or lidocaine with epinephrine in the nostril to optimize the visual field and provide anesthesia, decongestion, and hemostasis


   imagesDosing for nasal phenylephrine


      images6 months to 2 years: 1 to 2 drops per nostril of a 0.1255 solution


      images2 to 6 years: 2 to 4 drops per nostril of a 0.1255 solution


      imagesOlder than 6 years: 2 to 3 drops per nostril of a 0.1255 solution


   imagesMake sure you have a good light source and suction


   imagesConsider anxiolysis or sedation in the uncooperative child, especially in those who require more urgent removal of the foreign body, as in the case of button batteries


















Methods of removal


Manual removal


Suction catheter


Positive pressure


Foley catheter


Cyanoacrylate glue


Nasal wash


imagesManual Removal


   imagesA directly visualized object can be removed with alligator forceps or a curette with or without the assistance of a nasal speculum


   imagesAlligator forceps are best used for easily grasped, solid or compressible (e.g., paper) objects in the anterior nostril


   imagesA round and smooth object may be removed with an angled wire loop/curette or right-angle hook. It is inserted along the nasal floor or septum until it is behind the object and rotated so that the angled end is caught behind the object; the object can then be pulled out (FIGURES 87.1 and 87.2).



images


FIGURE 87.1 Removal of an intranasal foreign body using forceps. (From Issacman DJ, Post JC. Nasal foreign body removal. In: Henretig FM, King C, eds. Textbook of Pediatric Emergency Procedures. Philadelphia, PA: Williams & Wilkins; 1997:684, with permission.)


   imagesIf no wire loop is available, a makeshift one can be constructed with a paperclip (FIGURE 87.3)


imagesSuction Catheter


   imagesUsing a small suction catheter connected to wall suction, gently put the suction catheter up to the visible side of the object


      imagesBe careful not push the object further back


   imagesWhen the object becomes attached to the end of the suction catheter, slowly withdraw both the catheter and the foreign body


   imagesRigid suction catheters usually work better than flexible catheters


   imagesThe presence of side holes will prevent the vacuum from occurring at the tip. Choose a catheter without side holes, or trim the catheter tip to remove the side holes, leaving only an end opening.


      imagesTrim any sharp edges from the cut end to prevent trauma


imagesPositive Pressure


   imagesThe parent or the physician can do this technique. The parent may assist with this procedure and therefore reduce the child’s anxiety.


   imagesInstruct the parent to gently occlude the nostril without the foreign body with finger pressure


   imagesGive one quick puff of air into the child’s mouth


      imagesTo put the child at ease, the parent can say she/he is going to give the child a big kiss


   imagesThe puff of air should push the foreign body out of the nostril



images


FIGURE 87.2 From left to right—alligator clips, right-angle hook, nasal speculum.

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Nasal Foreign Body Removal
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