Chapter 47. Foreign Body Removal: Nasal Cavity

• • Foreign body lodged in the nasal cavity.

Absolute

• • Respiratory distress.

  • Penetrating injury.

  • Bleeding diathesis.

  • Disc battery impaction.

Relative

• • Fractured nasal bone.

  • Inability to visualize the foreign body.

• • 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 instrument removal.

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

  • The first attempt is the best attempt.

Parent Kiss Technique

• • 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.

Instrument Removal Technique

• • 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.

Positive Pressure Techniques

• • 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 ...