Definition
The Heimlich maneuver, also known as abdominal thrusts, is a first-aid technique used to help someone who is choking on a foreign object that’s blocking their airway. It’s a quick, forceful method that can save a life in seconds.
Purposes
- To prevent airway obstruction.
- To remove foreign body from trachea.
Procedure
| Nursing action | Rationale | |
| 1. | Assess airway for complete or partial blockage. (Partial airway obstruction will have some air exchange. Complete airway obstruction will have weak, ineffective cough and signs of respiratory distress). | Assessment ensures prompt and adequate management. If there is good air exchange and the patient is able to forcefully cough, do not interfere with the patient’s attempts to expel the foreign body. Encourage attempts to cough. If complete airway obstruction is apparent, the Heimlich maneuver or alternative method of subdiaphragmatic thrust should be performed immediately. |
| Conscious adult patient (sitting or standing): Stand behind the patient. | Proper positioning is necessary to provide an effective subdiaphragmatic thrust. | |
| Wrap your arms around the patient’s waist. Make a fist with one hand and grasp the fist with your other hand, placing the thumb side of the fist against the patient’s abdomen. The fist should be placed midline, below the xiphoid process and lower margins of the ribcage and above the navel. | Correct hand placement is important to prevent internal organ damage. | |
| Perform a quick upward thrust into the patient’s abdomen: Each thrust should be separate and distinct. | Produces artificial cough by forcing air from the lungs. | |
| Repeat this process six to ten times until the patient either expels the foreign body or loses consciousness. | Attempts to dislodge food or a foreign body to relieve airway obstruction should be continued as long as necessary because of the serious consequences of hypoxia. | |
| 2. | Unconscious adult patient or patient who becomes unconscious: | |
| Position the patient supine. Kneel aside the patient’s thighs. | Proper positioning of victim and rescuer is necessary to provide an effective subdiaphragmatic thrust. | |
| Place the heel of one hand midline, below the xiphoid process and lower margin of the ribcage and above the navel. Place the second hand directly on top of the first hand. | Proper positioning of the heel of hand is necessary to provide an effective subdiaphragmatic thrust. | |
| Perform a quick upward thrust into the diaphragm, repeating 6-10 times. | Patient who is unconscious may become more relaxed so that the previously unsuccessful Heimlich maneuver may be successful. | |
| 3. | For an infant who is choked: Place the infant stomach-down across your forearm. Give five quick forceful blows on the infants back with the heel of your hand. | |
| 4. | Perform a finger sweep: Use one hand to grasp the lower jaw and tongue between your thumb and fingers and lift. This will open the mouth and pull the tongue away from the back of the throat. | |
| Insert the index finger of the other hand into the patient’s mouth next to the cheek and using a hooking motion dislodge any foreign body. Caution must be taken to prevent pushing the foreign body farther down into the airway. | Should be used only in the unconscious patient who will not fight with the action. | |
| 5. | Open the patient’s airway and attempt ventilation. | The brain can suffer irreversible damage if it is without oxygen for over 4-6 minutes. |
| 6. | Continue sequence of Heimlich maneuver, finger sweep and rescue breathing as long as necessary. | Lifesaving efforts must continue until they are successful or until the rescuer becomes exhausted and cannot go on. |
| 7. | Record in nurses record the procedure performed, patient’s condition, and effectiveness of treatment. | Acts as a communication between staff members. |
Special considerations
- If a choking victim is pregnant or extremely obese, place your fist on the chest instead of the abdomen for the thrusts.
- It is important to wrap your fingers around your thumb when performing the Heimlich maneuver so as not to perforate the spleen with an extended thumb.
- The universal sign of airway obstruction is clutching the neck with hands. In addition, the inability to talk or breathe as well as cyanosis and progression to an unconscious state.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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