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  • • Foreign body lodged in the nasal cavity.

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Absolute

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  • • Respiratory distress.

    • Penetrating injury.

    • Bleeding diathesis.

    • Disc battery impaction.

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Relative

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  • • Fractured nasal bone.

    • Inability to visualize the foreign body.

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• The equipment needed depends on the method of removal.
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  • • 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.

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• Risks depend on the method of removal.
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  • • 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).

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  • • 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 instrument removal.

    • Never use irrigation to remove disc batteries, vegetable matter, or expansible objects (eg, sponge).

    • The first attempt is the best attempt.

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Parent Kiss Technique

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  • • 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 used.

    • 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.

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Instrument Removal Technique

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  • • 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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Positive Pressure Techniques

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  • • Can be performed in several positions:

    • • Child sits upright on the examining table or reclines back against a parent who is sitting on the examining table.

      • Child stands with back and head against a wall.

      • Child lies supine on the examining table.

    • For the parent kiss and self-expel techniques, ...

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