ILLUSTRATIVE CASE
Nasal Disc Battery Removal A Novel Technique Using a Magnetic Device Michelle J. Alletag, MD,* Donald Jacobson, RN,Þ Karen Santucci, MD,þ and Antonio Riera, MDþ
Abstract: Disc batteries as foreign bodies present challenges in both diagnosis and management and carry a high risk for complications. We describe a novel device for disc battery removal using a magnet and basic medical supplies readily available in the emergency department setting. We also review diagnosis, complications, and management recommendations for disc batteries as foreign bodies. Key Words: disc battery, foreign body, button battery, magnet battery extraction (Pediatr Emer Care 2014;30: 488Y490)
CASE A 3-year-old girl presents to the emergency department with her mother who suspects a nasal foreign body insertion. The child was able to verbalize that she placed something in her nose on the day of presentation, but the insertion was not witnessed. Upon inspection, the mother noted something ‘‘shiny’’ in her daughter’s right nostril. There has been no intercurrent illness, choking, drooling, or difficulty in breathing. A triage nurse assessed that there was visible foreign body in the right nostril, which seemed like ‘‘the back of an earring.’’ While waiting to see a physician, several digital attempts to remove the foreign body were performed by the mother and were unsuccessful. Upon initial inspection, the right nostril was edematous and swollen, and there was a hint of a gray object visible posterior to the inferior turbinate. The nasal passage had significant edema, so complete visualization and identification of the foreign body was not possible. An attempt at removal with a suction catheter yielded only black particulate matter. A dose of nasal phenylephrine was administered, and shortly after, an attempt at removal using a 6F balloon catheter was made. Again, black particulate matter was obtained without definite foreign body removal, and the child developed a brief episode of epistaxis from the right nostril. There was no aspiration event during this procedure. Repeat examination was significant only for persistent edema and tissue friability. At this point, an x-ray was obtained for further evaluation. The x-ray demonstrated a small circular radio-opaque foreign body with a bilaminar appearance highly suspicious for a button battery (Fig. 1). At this point, a retrieval device with a magnetic end was used (Fig. 2). This device was constructed by a member of our nursing staff. The device was carefully inserted into the right nostril until a click was felt when it came into contact with the foreign body. Using gentle traction, a button battery was easily From the *Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX; †Yale New Haven Hospital; and ‡Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT. The authors declare no conflict of interest. Reprints: Michelle J. Alletag, MD, 1935 Medical District Drive, Mail Code E2.03, Dallas, TX 75235 (e
Nasal Disc Battery Removal A Novel Technique Using a Magnetic Device Michelle J. Alletag, MD,* Donald Jacobson, RN,Þ Karen Santucci, MD,þ and Antonio Riera, MDþ
Abstract: Disc batteries as foreign bodies present challenges in both diagnosis and management and carry a high risk for complications. We describe a novel device for disc battery removal using a magnet and basic medical supplies readily available in the emergency department setting. We also review diagnosis, complications, and management recommendations for disc batteries as foreign bodies. Key Words: disc battery, foreign body, button battery, magnet battery extraction (Pediatr Emer Care 2014;30: 488Y490)
CASE A 3-year-old girl presents to the emergency department with her mother who suspects a nasal foreign body insertion. The child was able to verbalize that she placed something in her nose on the day of presentation, but the insertion was not witnessed. Upon inspection, the mother noted something ‘‘shiny’’ in her daughter’s right nostril. There has been no intercurrent illness, choking, drooling, or difficulty in breathing. A triage nurse assessed that there was visible foreign body in the right nostril, which seemed like ‘‘the back of an earring.’’ While waiting to see a physician, several digital attempts to remove the foreign body were performed by the mother and were unsuccessful. Upon initial inspection, the right nostril was edematous and swollen, and there was a hint of a gray object visible posterior to the inferior turbinate. The nasal passage had significant edema, so complete visualization and identification of the foreign body was not possible. An attempt at removal with a suction catheter yielded only black particulate matter. A dose of nasal phenylephrine was administered, and shortly after, an attempt at removal using a 6F balloon catheter was made. Again, black particulate matter was obtained without definite foreign body removal, and the child developed a brief episode of epistaxis from the right nostril. There was no aspiration event during this procedure. Repeat examination was significant only for persistent edema and tissue friability. At this point, an x-ray was obtained for further evaluation. The x-ray demonstrated a small circular radio-opaque foreign body with a bilaminar appearance highly suspicious for a button battery (Fig. 1). At this point, a retrieval device with a magnetic end was used (Fig. 2). This device was constructed by a member of our nursing staff. The device was carefully inserted into the right nostril until a click was felt when it came into contact with the foreign body. Using gentle traction, a button battery was easily From the *Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX; †Yale New Haven Hospital; and ‡Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT. The authors declare no conflict of interest. Reprints: Michelle J. Alletag, MD, 1935 Medical District Drive, Mail Code E2.03, Dallas, TX 75235 (e
