How to Perform Positive Pressure Technique for Nasal Foreign Body Removal

While there are several ways to attempt removal, using high-flow oxygen or medical air in the contralateral nostril delivered through suction tubing is a safe alternative to more traditional techniques and utilizes equipment easily found in every emergency department. This technique allows for a quick, clean, and painless way to dislodge a nasal foreign body with a high rate of success.

 Nasal Foreign Bodies – Positive Pressure Technique

We have all been there… whether at work at home… looking at a child in disbelief: “why would you put that up there?” Inevitably, what goes up, must come down. But how? There are various instruments, all fun to use and scary for a child to see near his or her face. One technique which is often over-looked and under-valued is the “positive-pressure technique” or “kissing technique.”

 The art of removing nasal foreign bodies

The removal of nasal foreign bodies (NFBs) can be a difficult task for the inexperienced physician, and the more unsuccessful attempts are made, the more difficult the extraction becomes. We have formulated this simple “four-step” approach to improve success, especially on the first try.

 “The Mother’s Kiss”

This technique was first described in the 1960s by a general practitioner in New Jersey and uses positive pressure to mobilize the foreign body from the nasal passage. It is effective in approximately 60% of attempts5, and generally most effective for smooth/soft foreign bodies that totally occlude the anterior nasal cavity.

20 ways of removing a nasal foreign body in the emergency department

Nasal foreign body (NFB) is a common presentation to the emergency department (ED). It is often a dilemma for the treating physician to choose the best method as removal of NFB can be challenging, frustrating and distressing for the physician, the patient, and the patient’s parents.

Ear, Nose, and Throat Foreign Bodies

Nasal foreign bodies are most commonly found in pediatric patients and often include many of the same objects as foreign bodies in the ear canal. Once the foreign body is located, there are several easy techniques to remove them without additional instrumentation.

Nasal foreign body Sedation

Ketamine for procedural sedation can be given intravenously or intramuscularly. The dose of ketamine to produce profound dissociation is: 1 to 1.5 mg/kg IV This is given over 1-2 minutes, is effective within 1-2 minutes, results in effective sedation lasting 10-20 minutes, and if inadequate a further 0.5 mg/kg dose may be given OR 4 to 5 mg/kg IM This is effective within 2 to 5 minutes, results in effective sedation lasting 15-30 minutes and a repeat IM dose (2-4 mg/kg) can be given after 10 to 15 minutes if the initial effect is inadequate

The Ole' Bead in the Nose

If you don't have a Katz extractor, this can also be done with a Foley.

Trick of the Trade: Nasal foreign body removal using foley catheter

Although not reported, this may be a technique theoretically to avoid in very posterior foreign bodies as they may be at increased risk for aspiration.