Airway Foreign Object Removal

  • Assess patient for signs and symptoms of airway obstruction. 
  • Perform hand hygiene and apply clean gloves. 
  • Suction any blood or mucus you can visualize in the patient's mouth. 
  • Remove broken or loose-fitting dentures. 
  • Be prepared to perform more definitive airway management, such as cricothyrotomy. 
  • Before performing abdominal thrusts on the conscious adult or child, ask the person if he or she is choking. If the victim nods yes and cannot talk, communicate that you are going to help.

 Conscious Adult and Child Older Than Age 1 Year

  1. Stand or kneel behind the victim and wrap your arms around the victim's waist. 
  2. Make a fist with one hand and place the thumb side of your fist against the abdomen of the victim, just above the navel but below the xiphoid process. 
  3. Grasp your fist with your other hand and press into the victim's abdomen with a quick upward thrust. 4.  Repeat thrusts, each as a separate, distinct movement, until the object is expelled or the victim becomes unresponsive. 
  4. For the pregnant or obese patient, the chest thrust may be performed. The patient may be supine, sitting or standing. Put one hand directly over the other, and position the bottom hand at the midsternal area above the xiphoid process (mid-nipple line, the same position used in external cardiac massage). Thrust straight down toward the spine. If necessary, repeat chest thrusts several times to relieve airway obstruction. 
  5. If the victim becomes unresponsive, open the airway, remove any object you can see, and begin cardiopulmonary resuscitation (CPR). Each time the airway is opened for breaths, assess for an object and remove it if seen. If nothing is seen, continue with CPR. 
  6. For a complete obstruction in an unconscious patient, where thrusts are ineffective, a physician or advanced practice nurse uses Magill forceps with direct laryngoscopy prior to ventilation to facilitate removal of the obstruction or surgical cricothyrotomy.
Conscious Infant (Younger Than Age 1 Year)
  1. Kneel or sit with the infant in your lap and hold the infant prone with the head slightly lower than the chest. Support the infant's head and jaw with your hand. 
  2. Deliver up to five forceful back slaps between the shoulder blades using the heel of your hand. 
  3. Turn the infant supine, supporting the head and neck and keeping the infant's head lower than the trunk. 
  4. Give up to five quick downward chest thrusts in the same location as for chest compressions, just below the nipple line. Deliver thrusts at a rate of about one per second with enough force to dislodge the foreign body. 
  5. Repeat steps 1 through 4 until the object is expelled or the infant loses consciousness. 
  6. If the infant becomes unresponsive open the airway, remove any object you can see, and begin CPR. Each time the airway is opened for breaths, assess for an object and remove it if seen. If nothing is seen, continue with CPR. 
  7. For complete obstruction in which ventilation is not possible, a physician or advanced practice nurse uses Magill forceps with direct laryngoscopy to facilitate removal of the obstruction or performs a cricothyroidotomy.
Post Procedure
Remove gloves and perform hand hygiene. 
Document the procedure in the patient's record.
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