Paper clips - Not just for clipping paper anymore

Paper clips - Not just for clipping paper anymore

I would like to congratulate the inventor of the modern paperclip, Johan Vaaler. Over the years, there have been numerous types of paper clips. As a matter of fact, forensic experts can often date documents by the type of paper clip that was used.

In the daily practice of medicine, paper clips are often a cause of injury (like those people who try and dig earwax out of their ears with them, or the very unfortunately people that accidentally swallow them), and sometimes we use them as medical instruments.

Yesterday, I had ANOTHER child come in to my office with a nasal foreign body. This five-year-old boy decided, for whatever undisclosed reason, that a big, white, plastic bead might be nice to insert in his left nostril.

The big fear of nasal foreign bodies is the potential that the child will snort it back and aspirate it into his lungs. Taking a bead out of the nose is a much easier task that fishing one out of the lungs, I can assure you. Anyway, foreign bodies in the nose can be relatively easy to remove or, in this case, a real challenge. Sometimes, the child has to be sedated or even brought into the operating room.

First step...try and get the child to forcefully blow the nose. By occluding the non-beaded nostril, I tried to get him to simply blow it out. Of course, that is assuming that he knows how to blow his nose - not a universal skill practiced by all children. This little boy was a sniffer. Every time that I asked him to blow he would simply snort it further up his nose, so this was not going to work.

Next step...try and grab it with some forceps. I have a variety of Medieval-looking forceps that I arranged on the table in front of this very apprehensive boy. Selecting a plain 'ol clamp-like forcep, I discovered that it would not open wide enough inside a little nose to grasp this now-slippery (from mucous) bead. It also pushed the bead further up the nose. A special foreign body forcep that opens like a deranged alligator was also tried to no avail. Tweezer-like instruments also failed.

Next, I tried suction. In order for suction to work, you must first have (a) a cooperative patient (I did not), (b) a good suction device, and (c) an object that can physically be sucked out. This bead was really jammed in there and all of my efforts failed to dislodge it.

Next, I tried incorporating the services of the mother. This method has worked for me in the past on younger children. I had the Mom give the child a "little kiss on the lips" - basically instructing the mother to puff some air into the mouth. Sometimes, this will force air out of the nasal passage and dislodge the bead. Again, the five-year-old resisted this very strange technique and it failed.

Having never met a bead I couldn't beat, I starting looking around for some other found objects. I felt a bit like MacGyver. Yes, a paper clip! Using some of my now-discarded instruments, I fashioned my own custom-made bead-retriever. Within seconds, I was able to get behind the bead and pop it out. Bingo! With hundreds of dollars of high-tech medical instruments lying on the exam table a simple paper clip saved the day.

I added this big 'ol bead to the bizarre collection of foreign bodies proudly displayed on my bulletin board, and took a picture of the little boy holding it. The Boo-Boo Gallery is a cute photo display in the hallway of my clinic. Right now, there are several HUNDRED pictures on it and a growing collection of objects fished out of curious kids.

In the past, I have also used a paper clip (heated and sterilized) to evacuate blood under the nail (subungual hematoma) from those people that miss the nail but hit their thumbs with a hammer. I even did this on my own two-year-old when she dropped a big can of baked beans on her toe at the grocery store.

So, thank you, Mr. Vaaler. Little did you realize when you invented the paper clip in 1899, that it would do more than hold our papers together.

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