Removal of Foreign Body (Nose)
Step 1: Health history and physical assessment
Health history:
- Children presenting with unilateral nasal discharge with a foul odor should be assumed to have a nasal foreign body until proven otherwise.
- Assess for pain, discharge, visible foreign body, anxiety.
Physical assessment:
- Visualization of foreign body with nasal speculum and/or light source.
- A topical vasoconstrictor (ex: oxymetazoline) can help dry the nares of blood and/or mucus to allow for better inspection/examination of the nasal cavity.
- A topical anesthetic (e.g., lidocaine) may assist in patient comfort and cooperation.
Step 2: Position the patient
Position the patient supine or in a position of comfort.
Step 3: Determine the technique to be used
Considerations:
• The nature of the foreign body should help guide the decision regarding the chosen technique.
• Choose a technique that will most likely allow successful removal of the foreign body on the first attempt.
• A foreign body that might break into smaller pieces with the use of forceps may be better removed with using a positive pressure technique, glue, or a catheter.
• The nature of the foreign body should help guide the decision regarding the chosen technique.
• Choose a technique that will most likely allow successful removal of the foreign body on the first attempt.
• A foreign body that might break into smaller pieces with the use of forceps may be better removed with using a positive pressure technique, glue, or a catheter.
i) Positive Pressure Technique
This is most effective for cooperative patients, typically over the age of 3 years. Instruct patient to occlude unaffected nostril and blow nose to dislodge foreign body.
The “parent’s kiss” technique is useful for infants and toddlers.
• Position patient supine
• Have caregiver occlude unaffected nostril
• Instruct caregiver to blow forcefully into the patient’s mouth to dislodge foreign body from nostril.
ii) Mechanical Extraction
• Position patient for comfort.
• Re-examine nose with otoscope/nasal speculum to confirm presence and position of foreign body.
• Gently and slowly insert the curette or forceps.
• Soft objects or those with protruding surfaces/irregular edges can be removed using the alligator or bayonet forceps.
• Objects that are round or breakable, insert cerumen curette just past foreign body then carefully withdraw.
• Re-examine nose with otoscope/nasal speculum to confirm presence and position of foreign body.
• Gently and slowly insert the curette or forceps.
• Soft objects or those with protruding surfaces/irregular edges can be removed using the alligator or bayonet forceps.
• Objects that are round or breakable, insert cerumen curette just past foreign body then carefully withdraw.
iii) Catheter Technique
• Apply vasoconstrictor; consider topical anesthetic as needed.
• Using a 12 Fr catheter, insert the tip into the naris past the foreign body
• Slowly inflate the balloon using approximately 2 mL of air or water
• Gently and slowly withdraw the catheter with the balloon inflated to pull the object out of the nose.
• Using a 12 Fr catheter, insert the tip into the naris past the foreign body
• Slowly inflate the balloon using approximately 2 mL of air or water
• Gently and slowly withdraw the catheter with the balloon inflated to pull the object out of the nose.
iv) Glue
• Apply a small amount of glue to the blunt end of the cotton-tipped handle applicator or the tip of the unfolded paper clip.
• Gently and slowly touch the tip with glue to the object (some glues may take 60 seconds to adhere to the object).
• Pull object out of the nose.
• Gently and slowly touch the tip with glue to the object (some glues may take 60 seconds to adhere to the object).
• Pull object out of the nose.
Step 4: Re-examine naris
Ensure all objects have been removed.
Step 5: Control epistaxis if present
See chapter titled “Epistaxis Management” for full procedure.
