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Respiratory Outpatient Clinic: Update for Providers

Updated: December 2, 2020

Due to the COVID-19 pandemic, the Children’s Mercy Respiratory Outpatient Clinics (ROC) will remain closed at all locations this fall and winter.

In order to support you and the families you care for, we have created some additional resources this year to navigate this tough season.

Nasal aspiration with a bulb tip


Use a bulb syringe or nasal aspirator attached to oral suction by the parent, or portable or wall suction source to suction mucous from the nose. Put two drops of normal saline (saltwater) in each nostril before suctioning. This may help remove more mucous. Suction before feeding, before sleeping, or if your child appears uncomfortable.

Nasal aspiration is not considered an aerosol-generating procedure (AGP). Personal protective equipment when performing this procedure with suspected/confirmed COVID-19 patients should include contact (gown and gloves), and droplet (surgical mask) with eye protection.

Nasopharyngeal suction with a catheter


Use a catheter attached to a portable or wall suction source. After lubricating the catheter, gently advance it through the nostril and direct it toward the floor of the nasal cavity. Advance the catheter toward the lower pharynx, until the patient coughs or resistance is felt. At that point, apply suction and slowly remove the catheter.

Nasopharyngeal suction is considered an aerosol-generating procedure (AGP). Personal protective equipment when performing this procedure with suspected/confirmed COVID-19 patients should include contact (gown and gloves) and airborne (N-95 with goggles/face shield or PAPR) precautions.

The length of time a room should be shut down after an aerosol-generating procedure is dependent upon how many air exchanges occur per hour. If a room is not a negative pressure room, ideally the room should be shut down for 60 minutes before cleaning to allow tiny particles suspended in the air to settle.

Illustration of infant's head with tube running down nose ad throat with words that read "Nasopharyngeal" and "Nasal"

 

 

 

 

 

 

 

See complete guide on how to hook up suction in your practice.

There are also several videos available on-line that manufactures of nasal suction devices have created.

Escalation for care after hours


infographic reads "Difficulty breathing, sinking in above, below or in between ribs, Breathing faster than once per second, Trouble eating, due to congestion, Fever higher than 101 for more than five days, Signs of dehydration (no tears, dry mouth, or fewer wet diapers), If you have any other concerns, Contact your child’s regular doctor or call the Children’s Mercy Nurse Advice Line: (816) 234-3188. New! Our urgent care locations are available for telehealth and in-person visits seven days a week: Monday – Friday, Noon – 10 p.m., Weekends, 10 a.m. – 8 p.m., Telehealth visits can help you determine if your child needs to be seen for in-person care, Select a visit time and check-in online at childrensmercy.org/savemyspotFor patients who need to be seen at Children’s Mercy urgent care centers or the emergency department for suctioning, we will focus on providing nasal aspiration rather than nasopharyngeal suctioning, when possible, to reduce the amount of aerosol-generating procedures.

New! Our urgent care locations are available for telehealth as well as in-person visits seven days a week:

  • Monday – Friday, Noon – 10 p.m.
  • Weekends, 10 a.m. – 8 p.m.

By expanding our telehealth availability, families can connect with a provider who can assess their child and help determine if escalation of care is necessary. Historically families have expressed that part of the value of ROC is the ability to see a health care professional who can provide them peace of mind by assessing their loved one, and then offering guidance around escalating care, and/or letting them know their child looks comfortable enough to stay home.

Additional resources for your patients


The Respiratory Care team at Children’s Mercy has developed a guide for parents on how to use a manual nasal aspirator when providing suction for their infant at home. We encourage you to share this resource with your families:

We also have created patient information regarding bronchiolitis that you can find on our Bronchiolitis Family Engagement Education page.

For questions reach out to physicianservices@cmh.edu.