• Vasoconstrictor nasal spray or drops (.25% phenylephrine hydrochloride).
• Topical anesthetic (1–4% lidocaine).
• Alligator forceps.
• Right-angle hook.
• Ear curette (metal or plastic).
• Nasal speculum.
• Suction apparatus.
• Self-inflating ventilation bag (ie, Ambu) and mask.
• Failed or incomplete removal (10–30%).
• Epistaxis (10–30%).
• Psychological stress (minimal if parent kiss technique is used).
• Septal hematoma or perforation (rare).
• Aspiration (rare).
• The parent kiss technique is the least invasive
method and should be attempted first for smooth objects lodged high in
the nasal passage.
• Precede all attempts with vasoconstrictive nose drops to minimize
bleeding and reduce edema.
• If the child cannot be adequately restrained, do not attempt
• Never use irrigation to remove disc batteries, vegetable matter,
or expansible objects (eg, sponge).
• The first attempt is the best attempt.
• Explain to the child that his or her parent will
give him or her a special kiss on the mouth to remove the object.
• The child will need to keep his or her mouth open for the kiss.
• This is the only cooperation required, and there will be no instruments
• Explain to the parent, out of earshot of the child, that the
parent must blow with 1 forceful puff into the child’s
mouth while simultaneously occluding the uninvolved nostril.
• If successful, the object will be expelled from the nasal cavity,
obviating the need for instrument removal.
• The technique is less frightening to the child and less likely
to result in local trauma.
• Reassure the child that no needles will be used.
• Show the child the instrument that you are going to use and let
him or her feel that it is not sharp.
• Explain that holding still is extremely important in order to
minimize the likelihood of pain.
• Warn the parent that small amounts of bleeding are common.
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