A finger sweep is a manual intervention used to attempt the removal of a foreign object lodged in the upper airway during a life-threatening emergency. This technique involves inserting a finger into the mouth and throat to dislodge the obstruction. It is reserved solely for situations where traditional airway-clearing maneuvers, such as abdominal thrusts or back blows, have failed and the person has become unresponsive. Because this action directly manipulates the airway, improper use carries a significant risk of causing severe harm or worsening the obstruction.
Defining the Safety Parameters
The decision to perform a finger sweep is governed by two absolute prerequisites that must be met simultaneously. The primary rule dictates that the person must be unconscious, meaning they are unresponsive and have stopped breathing or are gasping for air after other attempts to clear the airway have been unsuccessful. This is because a conscious person may instinctively bite down or struggle, which could lead to injury for both the rescuer and the victim.
The secondary rule is that the foreign object must be clearly visible within the back of the throat or mouth. The object should be within easy reach and appear loose enough to be removed without force. If the object cannot be seen, a finger sweep must not be attempted under any circumstances.
The practice of a “blind finger sweep,” where a finger is inserted without visual confirmation of the obstruction, is strongly contraindicated by current emergency protocols. Inserting a finger blindly risks pushing the object deeper into the pharynx or trachea, turning a partial obstruction into a complete one. This action can also cause trauma to the delicate tissues of the throat, complicating subsequent medical intervention.
Step-by-Step Technique for Adults and Older Children
Once an adult or older child is unconscious and the foreign object is visible, the procedure can begin. The person should be positioned lying flat on their back on a firm surface for stability. The rescuer should open the person’s mouth using the cross-finger technique, placing a thumb on the lower teeth and an index finger on the upper teeth to gently separate the jaw.
The rescuer uses their index finger to perform the sweep, extending it along the inside of the cheek toward the base of the tongue. The finger is then curled into a hook shape, attempting to trap the visible object. The motion should be a single, controlled sweep across the back of the throat and out of the mouth to dislodge the foreign material.
The rescuer should make only one attempt to remove the object using this sweeping motion. If the object is not successfully removed, a second sweep is generally not recommended as it increases the risk of pushing the object deeper. The rescuer should then proceed with standard cardiopulmonary resuscitation (CPR), which includes chest compressions that may help to expel the object from the airway.
After a successful sweep, or after a cycle of CPR, the rescuer must immediately check the person for breathing. If breathing has not resumed, the rescuer should continue with CPR protocols, including attempting rescue breaths. The index finger is used for adults and older children due to the larger size of the oral cavity.
Why Infant Sweeps Require Different Protocols
The standard finger sweep technique is inappropriate and dangerous for infants (children under one year of age). The primary reason for this distinction is the anatomical difference in the infant’s airway. An infant’s throat and vocal cords are much smaller and more delicate than an adult’s.
A finger, even a small one, can easily push a foreign object past the vocal cords and into the narrow trachea, causing a complete and potentially fatal obstruction. Furthermore, the risk of causing damage to the soft tissues of the pharynx is significantly higher in infants. The small oral cavity also makes it difficult for a rescuer to visualize the object clearly or to maneuver a finger effectively.
For an infant who is choking, the recommended protocol is a sequence of five back blows followed by five chest thrusts, which use air pressure to try and dislodge the object. Only if the infant becomes unconscious and the object is clearly visible should a manual removal be considered. In this rare circumstance, a rescuer should use their pinky finger, rather than the index finger, due to its smaller size.
Even when the object is visible, non-medical personnel are strongly cautioned against attempting any deep extraction in an infant. The first aid sequence of chest compressions, as part of CPR, is the primary recommendation for an unconscious infant, as the compressions themselves can often create enough pressure to expel the object. If the object is seen during the process of CPR, it can be gently scooped out with the pinky, but only if it is completely accessible.