Nasal foreign body: Difference between revisions
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==Methods== | ==Methods== | ||
*Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts. | *Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts. | ||
*Keep patient upright to avoid FB going back into airway | |||
**Can sit on parent's lap with parent hugging / restraining arms | |||
*Can use a c-collar to prevent side to side motion | |||
#"Parent's Kiss" - like performing mouth to mouth. Have parent close contralateral nare, form tight seal over child's mouth. Perform short, sharp blow of air into patient's mouth to expel FB | #"Parent's Kiss" - like performing mouth to mouth. Have parent close contralateral nare, form tight seal over child's mouth. Perform short, sharp blow of air into patient's mouth to expel FB | ||
#BVM technique - similar to "Parent's Kiss" technique - close opposite nare, use BVM with tight fit over mouth only, squeeze bag to provide short, sharp blow of air | #BVM technique - similar to "Parent's Kiss" technique - close opposite nare, use BVM with tight fit over mouth only, squeeze bag to provide short, sharp blow of air | ||
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#Curette (lighted may be helpful) | #Curette (lighted may be helpful) | ||
#Dermabond on end of long q-tip | #Dermabond on end of long q-tip | ||
**Use a disposable speculum to shield the nares so you don't accidentally glue the q-tip to the skin | |||
#Balloon catheter (e.g. foley catheter or fogarty catheter or commercial Katz extractor) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare | #Balloon catheter (e.g. foley catheter or fogarty catheter or commercial Katz extractor) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare | ||
#Suction (can make own with small caliber ETT cut short or 14 Fr suction catheter cut short) | #Suction (can make own with small caliber ETT cut short or 14 Fr suction catheter cut short) | ||
Revision as of 22:51, 22 July 2016
Background
- Common foreign bodies (FB) include food (beans, nuts, gum), marbles, batteries, beads, magnets, jewelry, stones, tissue, etc.
- Suspect foreign body in a patient with unilateral purulent or bloody nasal discharge or unilateral sinusitis even if no history of FB insertion.
- Small children may need Procedural Sedation (Peds) for removal efforts.
- Radiographic imaging unlikely to be helpful.
- Exception: if suspect nasal FB but don't see one, consider radiography to rule out button battery or magnets across septum prior to discharge and follow-up with ENT
Methods
- Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts.
- Keep patient upright to avoid FB going back into airway
- Can sit on parent's lap with parent hugging / restraining arms
- Can use a c-collar to prevent side to side motion
- "Parent's Kiss" - like performing mouth to mouth. Have parent close contralateral nare, form tight seal over child's mouth. Perform short, sharp blow of air into patient's mouth to expel FB
- BVM technique - similar to "Parent's Kiss" technique - close opposite nare, use BVM with tight fit over mouth only, squeeze bag to provide short, sharp blow of air
- Alligator forceps or Bayonet forceps
- Curette (lighted may be helpful)
- Dermabond on end of long q-tip
- Use a disposable speculum to shield the nares so you don't accidentally glue the q-tip to the skin
- Balloon catheter (e.g. foley catheter or fogarty catheter or commercial Katz extractor) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare
- Suction (can make own with small caliber ETT cut short or 14 Fr suction catheter cut short)
Complications
- Tympanic membrane barotrauma from "Parent's Kiss" or BVM technique
- Bleeding
- Displacement of foreign body into airway
- Tissue necrosis (batteries and magnets)
Disposition
- Most patients can be discharged
- If unable to remove FB, or if complications → refer to ENT
- If foreign body is button battery or multiple magnets (esp strong rare earth magnets), requires immediate removal in ED. Consult ENT if needed.
See Also
References
- Harwood-Nuss, Roberts and Hedges