Equipment Needed (Figure 1)

• Wall suction unit
• Suction tubing adapter
• Suction tubing
• Yeah, that’s it!

1. Have the patient sit up, lean slightly forward, and tilt the head down.
2. Ensure wall oxygen is available, and attach one end of the standard suction tubing to the wall oxygen or compressed air. The opposite end of the suction tubing should have the plastic suction tubing adapter piece firmly implanted (see Figure 2).
3. Place the tubing with the attached adapter into the nostril contralateral to that containing the foreign body (see Figure 3).
4. Titrate the wall oxygen or medical air to high flow (usually 10–15 L/min) until the foreign body becomes dislodged. Periorbital emphysema or blowing a globe out of its socket reflects a lack of understanding of the term titration.

Figure 1. Wall suction unit, a suction tubing adapter, and suction tubing.
Figure 2. Assembly for the positive pressure technique.
Figure 3. Place the tubing into the nostril contralateral to the foreign body.

Patient Selection

This technique may be most applicable for cooperative pediatric patients. However, nasal foreign bodies are not always a problem unique to the pediatric population. Often, adult psychiatric patients will place objects where they do not belong, including the nose.

This technique may be inappropriate for patients who are not amenable to having suction tubing inserted into their nostril. In the case of an uncooperative but otherwise nonviolent pediatric patient, this minimally invasive approach is still of value because it can be performed under procedural sedation or with the use of a papoose.

Caution

Complications from removal of nasal foreign bodies are infrequent, regardless of the approach clinicians choose. Navitsky et al reported no complications with the nasal positive pressure technique using wall oxygen for removal.1 A comprehensive review of nasal foreign body removal by Kiger et al reports no known complications from positive pressure techniques, including the Parent’s Kiss, Big Kiss, nasal positive pressure, or Ambu bag.^2,3 As with any foreign body within or near the airway, aspiration is always a risk. In theory, by using positive pressure techniques such as the one described, the risk of aspiration should be lessened. Forcing air from the contralateral side should help expel the foreign body out of the nose as opposed to pushing it posteriorly into the airway. This is one advantage over the traditional methods of extraction such as Foley balloon catheters, Katz extractors, and other forms of mechanical extraction that may result in worsening the situation. Some known complications may include mucosal irritation, swelling, and bleeding.