Removing foreign bodies

"Do or do not. There is no try."   * 

Preparation

The guiding principle is to set everything up for success, and then to take the foreign body out. 

In the majority of cases, you will have one good chance to remove the foreign body before the patient's cooperation vanishes. This applies more in children and those with learning disability but equally, not many adults will stay still for an increasingly painful procedure.

• Keep everyone calm

• Talk frankly with the parents/carers - they need to be firm to be kind

• Brief them about the importance of holding the patient tightly (if applicable) and show them what you mean

• General anaesthetics involve risk and waiting, which can be avoided if you are successful on the first go

• Get help eg nurse or another doctor

• Ideally, do this in a room, as screaming puts other people off (just be honest with the parents)

• Make sure you can see the foreign body - get a good light or microscope that leaves your hands free

• Get your instruments ready

• Good restraint is very important, and if you aren't convinced that the parent or carer can be firm, you may want to consider other options (e.g. wrapping a small child in a blanket).

Removal

• Make sure the patient is as steady as possible

• Visualise the foreign body with anterior rhinoscopy / microscope depending on location

• Decide in advance which method is most likely to remove the foreign body.

• Often the preferred method is to use a blunt wax hook, especially for beads. Pass it behind the bead, rotate the hook so it is behind the bead, and roll the foreign body out.

• Zoellner suction catheters can be useful for sucking out secretions, soft food, or light, flat foreign bodies.

• Crocodile forceps run the risk of pushing the foreign body further in. They are only useful in flat foreign bodies such as cardboard.

• Have one good try

• Stop and reassess

Afterwards

• Cheer everyone up

• Offer to put the foreign body in the bin (giving it back is asking for trouble)

• Examine the ear again (if applicable) to ensure there is no otitis externa that requires treatment

* apologies to Yoda 

for foreign bodies in the lung

• Patients / parents would usually present with a a chest infection and a history of suspected inhalation not too long ago

• A chest-xray and chest examination is mandatory (decreased air entry / coarse crackles / bronchial breathing)

• Removal is done via a rigid bronchoscopy under GA

• The video in the attached link explains how to set up a bronchoscopy (https://www.youtube.com/watch?v=u0cBIFHwAAc&feature=youtu.be)

Page last reviewed: 10 December 2019