A 4-year-old boy presented with a pea in his right nostril. He was unable to blow the pea out because there was a fair amount of air passage around it, and he vigorously resisted attempts to remove it with forceps and ear curettes.
Suction would have been a good option, but the rigid Yankauer suction catheter was too large to fit in his nostril, and the smaller, metal suction catheters found in our ENT cart could cause a lot of damage if the child were to move his head suddenly while we were attempting removal. Lacerations of the nasal septum or a turbinate would have made a relatively simple problem a lot worse.
The solution was to make a semi-rigid suction catheter by attaching a pediatric endotracheal tube to the standard wall suction tubing. The endotracheal tube can be trimmed to the appropriate length, and by boring a hole in the base of the endotracheal tube, you can engage the suction when needed. (See photo.)
Set the wall suction at 100-140 psi, place the tip of the catheter next to the foreign body, engage the suction, and pull the foreign body out. If the child moves suddenly, the semi-rigid catheter should do much less damage than a rigid metal one.
The pea was easily removed, and we have since used the same system to remove several smooth foreign bodies from the noses and ears of other children. If you have a wide variety of suction catheters, you may not need this system, but if you don't, all of these items are found in virtually every emergency department, and they can easily be combined to make a useful suction catheter.