patient. These foreign bodies will have multiple removal techniques that are options based on the qualities of the foreign body. We will demonstrate the use of various extraction tools, as well as the removal through an endotracheal tube, an endotracheal tube in block, and then through the patient's oropharynx, describing why we have chosen that technique. I'm Laura Frey, I'm faculty at the University of Wisconsin and a member of the bronchoscopy domain task force. Hi, I'm Tim Mulga, I'm faculty at the University of Chicago and I'm the chair of education committee for CHEST. Hi, I'm Abdul Reyes, faculty at Rasmussen-Franklin University, innovation subcommittee, education committee at CHEST. If you were called for a foreign body in a patient's airway, we would encourage you to have a variety of tools available for use through your bronchoscope. We will very quickly review a few of the tools that we are going to demonstrate throughout this video, as well as a few additional options, and discuss some of the pros and cons of each of those tools and which objects you might use these to remove. The first item on our table is a set of rubber-tipped grasping forceps. These are an item that you may choose to use if you're called to remove something such as a sewing needle, a thumbtack, a hairpin, or an earring from a patient's airway. As you can see on the package, these are a set of grasping forceps that have a rubber tip to protect you from the sharp aspect of that object. The next item on our table is another set of grasping forceps. These are a larger set of rat tooth grasping forceps. These will be used to capture large objects in the airway, however should be used on objects that are unlikely to crumble or fall apart. The next object on the table is something that we might use for an object that has the potential to fall apart in a patient's airway. Things like peanuts, pieces of candy, something that would require you to remove this in one piece prior to instrumenting it and seeing little bits and pieces in the airway. Here we have two different wire basket objects that are both spiral type. They are slightly different sizes. So one is smaller, it's an 8 millimeter basket. The one here is a 9 millimeter basket. If you have a large object in the patient's airway that is likely to crumble, for example a large nut that you cannot grasp with one of these baskets, we have a zero tip large basket here which you can see is 16 millimeters and could be used to remove large objects from the patient's airway. If you are using this, keep in mind that that large object will not likely come through an endotracheal tube. So this is something that would need to be removed with the bronchoscope and the foreign body in the basket in block. If you are called to retrieve a foreign body and you know what the foreign body is, we would encourage you to consider practicing outside of the patient prior to attempting retrieval. As you do your airway inspection and you identify the foreign body in the airway, you will then proceed to identifying the tool that you would like to use for retrieval. Here the first object that we identify in our patient's airway is a pearl earring. We can identify the post of the pearl earring might be difficult to retrieve and might have some sharp edges that would stick in the patient's airway. As such, we have chosen to use a pair of rubber tipped grasping forceps to retrieve the pearl earring from the patient's airway. The second object we find in our patient's airway is a large raisin. You can imagine that the rubber tipped forceps will not be large enough to retrieve this and it's also a large object that is unlikely to be able to be retrieved using a basket. Here we will demonstrate the use of a rat tooth forcep to retrieve this object. This is a large object that might be removed in block given the unlikely chance that it will pass through the patient's endotracheal tube. The third object we are called to retrieve is a peanut. You can see that this peanut is already broken in half and that attempts to retrieve using a forcep might cause further crumbling of the peanut. As such, we decide to proceed with removal using a spiral basket. Once the peanut is inside the basket, the basket is closed and the object is removed from the airway.

foreign body removal

airway obstruction

grasping forceps

wire basket

practice outside patient