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 another nurse or doctor
  • Get senior help if available and you want backup (NB non-airway foreign bodies are non-urgent)
  • 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 holding is very important and if you aren't convinced that the parent or carer can be firm, you may want to consider other options; the worst thing would be to push the foreign body further in or to jab your instrument in the patient's eye

 

Removal

  • Make sure the patient is as steady as possible: held if a small child; head leaning against the couch with support from your assistant if an adult
  • Take a look at the foriegn body
  • Work out how to get it out
  • Yankauer suction catheters have some problems: 
    • Many have a hole on the side of the tip which allows air to flow through an alternate route
    • They don't work well on pellets etc. unless the pellet is the same size or smaller than the opening of the tip
    • They are usually so big you can't see well and end up poking the foreign body in further
    • Zoellner suction catheters are smaller and can be useful for sucking out secretions or light, flat foreign bodies (eg a googly eye); they can be found in ENT clinic or treatment rooms
      Above: A Zoellner catheter attached to suction tubing; below it is a small 'fine end' used for finer work

     

    Above: A Zoellner catheter attached to suction tubing; below it is a small 'fine end' used for finer work

     

    • Forceps ("tweezers") run the risk of poking the foriegn body further in as you can rarely get both prongs around the sides of the object
    • A good trick is to get a Jobson-Horne or other probe around the side of the foreign body and flick it out
    • Have one good go
    • Stop and reassess
      Above: using a Jobson-Horne probe extract a foreign bod

     

    Above: using a Jobson-Horne probe extract a foreign bod

     

    Afterwards

    • Cheer everyone up
    • Offer to put the foreign body in the bin (giving it back is asking for trouble)
    • Take a quick look at the orifice in question and treat accordingly - parents/carers may have to take the patient to the GP in a day or two if they are very upset

     

    * apologies to Yoda 

     

     

    Page last reviewed: 23 September 2016