Presence of foreign material within the nostril

CONTRAINDICATIONS

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

 If there is danger of obstructing the airway

TECHNIQUE

 Patient Preparation

    An uncooperative child should be properly immobilized or sedated

       An 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

    Using 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

    Dosing for nasal phenylephrine

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

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

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

    Make sure you have a good light source and suction

    Consider 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

 Manual Removal

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

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

    A 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).

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

 Suction Catheter

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

       Be careful not push the object further back

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

    Rigid suction catheters usually work better than flexible catheters

    The 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.

       Trim any sharp edges from the cut end to prevent trauma

 Positive Pressure

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

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

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

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

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

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