Children commonly shove objects up their noses or in just about any orifice they can find. It is our job to try to get these items out. Depending on the size and shape of the foreign body (FB), there are many techniques described for their removal. Objects that are not round and smooth can be removed directly using straight or alligator forceps.
Explore This IssueACEP News: Vol 28 – No 01 – January 2009
Items that are round and smooth can be difficult to grasp with forceps and may be pushed farther inward with each attempt to grab them. For such objects in the nose, one of the following indirect methods may be more appropriate. While covering the unaffected nostril, the child can blow forcefully through the affected nostril. Or, if the child cannot provide adequate force, a parent can blow into the child’s mouth instead. Although messy, this technique can be successful.
Alternatively, a small pediatric or neonatal Foley catheter can be inserted beyond the FB. After the Foley balloon is inflated, pulling it forward will also pull the FB forward. Both of these indirect techniques are hindered by the extensive soft tissue swelling that occurs in response to a foreign body, preventing it from being dislodged and/or preventing the catheter from passing beyond the object.
Fortunately, most objects that cannot be removed after a few attempts can be safely left in place for removal on a follow-up visit to an ENT specialist.
Button, or disk, batteries, however, are a special case. Batteries can cause destruction to surrounding tissues via liquefaction necrosis as the chemicals within them leak. For this reason, button batteries should be removed immediately to prevent further damage. In addition, unlike other objects that if swallowed will pass through the digestive tract without harm, batteries can cause necrosis to the tissues of the GI tract as well. All attempts should be made to prevent their being swallowed, and turning a relatively simple FB case into one requiring endoscopic removal.
PITrick of the trade: If magnets are useful during construction, why not in the emergency department? Most hardware stores sell a very small but very strong magnet. (See photo 1.) It is quite narrow and comes attached to a telescoping wand for reaching behind large obstacles and into crevices to retrieve screws, nuts, bolts, and small tools that have fallen out of reach. Coincidentally, this tool also fits perfectly into a toddler’s nose.