Manual removal of foreign body from the airway refers to the physical extraction of an object that is obstructing the respiratory tract—typically the trachea or bronchi—using non-invasive or minimally invasive techniques. This may include:
- Back blows and chest thrusts in infants
- Abdominal thrusts (Heimlich maneuver) in older children and adults
- Finger sweep or forceps removal if the object is clearly visible and accessible
The goal is to restore airway patency and prevent asphyxiation. It is a critical first aid or emergency procedure, especially in pediatric patients, where airway obstruction can rapidly become life-threatening.
Common Foreign Bodies
- Offending food items such as nuts, piece of carrot, popcorn, seeds, meat, grapes, and candy.
- Other items include plastic or glass beads, peas, button, and coins.
Signs of Foreign Body Aspiration
Foreign body aspiration should be seriously suspected in the case of spontaneous respiratory distress associated with:
- Coughing
- Gagging
- Stridor
- Hoarseness
- Cyanosis
- Wheezing
Procedure
Removal of Foreign Body in an Infant
Back blow and chest thrust.
- Hold the infant face down on your forearm, which in turn should rest on your thigh.
- Support head of your hand between the shoulder blades of the infant.
- Give five forceful blows on the infant’s back with heel of your hand.
- Now turn the infant around as a unit to a supine position while firmly supporting the head and neck.
- Administer up to five quick chest thrusts in a similar method and location as used for chest compression.
- The whole process may be repeated until the foreign body is expelled out.
Removal of Foreign Body in a Child Older than 1 Year
Subdiaphragmatic abdominal thrusts (Heim-lich maneuver) increase the intrathoracic pressure and create an artificial bout of cough, which forces foreign body out of the airway.
This maneuver is not employed in infants because of the risk of liver injury.
Heimlich maneuver in a conscious child
- Stand behind the child and encircle his torso by putting both arms directly under his axillae.
- Place the thumb side of the one fist against the child’s abdomen in midline, slightly above naval and well below xiphoid.
- With other hand, grasp the first and exert quick upward thrust taking care not to touch the xiphoid process or lower rib margin.
Each thrust should be forceful enough and intended to relieve obstruction.
Heimlich maneuver in an unconscious child
- Position the child in a supine position and kneel at his feet.
- Place the heel of one hand on child’s abdomen in the midline, slightly above the naval and well below the rib cage.
- Place the second hand on top of the first and press into the abdomen with quick upward thrust.
Nurse’s Responsibility
- Recognize the signs of foreign body aspiration and implement immediate measures to relieve the obstruction.
- Teach the Heimlich maneuver technique to parents to deal with such situation at home.
Important Notes
- Do not perform blind finger sweeps—this can push the object deeper.
- If trained and the object is visible, use forceps or a tongue-jaw lift to extract it.
- Always call emergency services immediately.
- After removal, monitor for airway edema, aspiration pneumonia, or residual obstruction
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 Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- 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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