Airway Foreign Body
Care of the Child and
Parent in Theatre
What is a Foreign Body?
Any object originating outside of the body
Foreign body (FB) aspiration is a leading cause of death
in children aged 1-3 years, with a peak incidence rated
in the 2nd year of life.
Food is the most common category of items aspirated;
with nuts, especially peanuts, being the most common
type of food.
Other non-organic foreign bodies include coins,
batteries, beads, and small toy pieces…
What is a Foreign Body?
History of Bronchoscopy
–
–
–
Gustav Killian performed the first bronchoscopy in
1897
In 1920 Chevalier Jackson refined the rigid
bronchoscope to be used with distal illumination.
Harold Hopkins developed today’s rod-lens
telescope in 1950.
Aspiration: Typical Causes
Foreign Body Aspiration is most common in Children
Lack of food grinding molars.
Running/Playing at time of aspiration
Lack of glottic closure and swallow coordination
Frequently placing foreign bodies in their mouth
Signs and Symptoms
Spectrum of symptoms depend on the Size,
Nature and Location of the FB
•
•
•
•
•
•
• Total Obstruction
Dyspnoea
Stridor/Wheeze
Apnoea
Coughing
Cyanosis
Choking
Pre-Operative Assessment
Physical assessment
Airway/Breathing/Circulation
Level of consciousness
History
Chest X-Ray
Fasting
The Gold Standard
“The Gold Standard for the diagnosis and
management of an airway foreign body, in children,
is rigid bronchoscopy under general anaesthetic.”
(Farrell, 2004)
What is a Rigid Bronchoscope?
–
–
–
A rigid bronchoscope is a hollow stainless steel
tube through which a rigid telescope is placed
They are available in varying lengths and external
diameters.
The “Storz” type ventilating bronchoscope is best
for use in children with an aspirated foreign body;
as it provides both a means of visualising the
airway and ventilation (Farrell, 2004)
Rigid Bronchoscope Equipment
Rigid Bronchoscopy
–
–
–
–
–
An invasive procedure
Preferred method of FB recovery as allows for
protection of the airway
Telescopes and Forceps used as enhancements
Successful in ~95% of cases.
Complications occur in ~1% of cases
Damage of teeth and gums
Tracheal and Bronchial tearing
Dislodgement of FB into dangerous position
Location and Personnel
Most appropriate location is operating theatre.
Efficient speed is absolutely essential.
Personnel should include
Surgeon
Two Anaesthetists
Anaesthetic Nurse
Dedicated Scrub Nurse
Circulating Nurse
Protocol for Bronchoscopy
Performed under
general anaesthetic.
Gas Induction.
Spontaneous
respirations.
Supplemental O2
Positioning
Equipment
Miscellaneous
materials
ET tube and
Tracheostomy
equipment
Family Centred Care
My colleague, Lisa, will now discuss Family
Centred Care in general and as it applies to the
treatment of Airway Foreign Bodies in children.
Family Centred Care
Family Centred Care
Family centred care is a way of caring for
children and their families within health
services which ensures care is planned
around the whole family and not just the child
Clinical skills on their own are insufficient in
caring for the child in hospital
Effects of hospitalisation on the child
and family
A child is not a small adult
Physical and cognitive development of a
child is different from that of an adult
Specific psychosocial and emotional needs
Vulnerable group as they may have limited
understanding and control over what is
happening to them
Effects of hospitalisation on the child
and family
Stressful experience for children
Fear of the unknown, unfamiliar faces, separation from parents
and siblings
Children perceive painful procedures such as blood tests and
surgery as threatening and traumatic
Children were worried about wearing a theatre gown, the
journey to theatre, waiting in theatre, having the operation and
waking up in pain
Children report feeling unsafe in the hospital setting
Effects of hospitalisation on the child
and family
As a result of stressful hospital experiences
children can experience anger, aggression,
regression, panic, apathy, anxiety and sleep
disturbances that can continue to persist after
hospital discharge
Very important that nurses understand the
potential effects hospitalisation may have on
children and their families
The Nurse’s Role
Understanding the stages of cognitive
development in children.
Piaget’s framework of cognitive
development(1953)
The sensorimotor stage 0-2 years
The pre-operational stage 2-7 years
The concrete operational stage 7-11 years
The formal operational stage 11 years+
Sensorimotor stage 0-2 years
Limited understanding
Minimisation of pain and physiological procedures
Separation from parents/caregivers extremely
traumatic in this age group
Use of infant’s blanket/teddy as a comfort during
separation from parents
The pre-operational stage 2-7
years
Eager to please but have limited coping strategies
Do not have concept of having internal organs
Very concerned with body integrity
Language used should be simple and reassuring
Information given should only be given the day before
procedure
Respond well to information provided through therapeutic play
Limited separation from parents/caregivers
The concrete operational stage 7-11
years
Increased ability to think logically
Awareness of internal organs and body functions
Terminology and language chosen carefully to
prevent misunderstanding
Separation from parents less of an issue
The formal operational years 11+
Understand why invasive procedures may be needed
Fear of waking up during procedure or death
Heightened awareness of body image, concerns
regarding surgical scars
More detailed explanations required
Independence from parents/caregivers evolve
Parents and Carers
Hospital admission extremely stressful for
parents
Good communication between nurse and
parents/caregivers valued by parents
Excessive verbal reassurance by parents
can increase child’s stress
Promote parental behaviours that enhance
child’s coping ability.
Parents and Caregivers
Interventions aimed at addressing parental
concerns regarding children’s hospitalization
have been effective in decreasing parental
anxiety and enhancing child behavioral
outcomes
Parents and Caregivers
References
Coyne, I., Neill, F. and Timmins, F. (2010). Clinical Skills in Children’s Nursing New
York: Oxford University Press.
Diaz-Caneja, A., Gledhill, J., Weaver, T., Nadel, S. and Garralda, E. (2005). A child’s
admission to hospital: a qualitative study examining the experiences of parents
Intensive Care Med 31(9) 1248-1254.
Coyne, I. (2006). Children’s experiences of hospitalization Journal of Child Health
Care 10 (4) 326–336.
E, Bedells. and Bevan, A. (2016). Roles of nurses and parents caring for hospitalised
children Royal College of Nursing 28 (2) 24-27.
Le Roy, S., Marsha Elixson, E., O’Brien, P., Tong, E., Turpin, S. and Uzark, K. (2003).
Recommendations for Preparing Children and Adolescents for Invasive Cardiac
Procedures Circulation 108 2550-2564.