Nasal Foreign Body Removal

imagesPresence of foreign material within the nostril


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


   imagesChoose method of removal


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).


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


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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