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Inpatient Nasal Suction

For the child with bronchiolitis, when should nasal suctioning (with a bulb tip) or nasopharyngeal suctioning (with a catheter) be used to clear secretions?

Bronchiolitis team recommendation: Based on low quality evidence, the Bronchiolitis CPG Team recommends the use of nasal suctioning as the primary route for removing respiratory secretions. Nasopharyngeal (NP) suctioning may be used if signs of labored breathing continue after nasal suctioning. We placed high value on amelioration of labored breathing and decreasing potential adverse effects of deep suctioning. One low quality study reports reduction in visible and audible secretions with NP suctioning. However, a QI project completed at Children's Mercy Hospital Kansas by Jarvis et al (2012) showed similar hospital readmission rates, admissions to the PICU, parental satisfaction, and average length of stay when nasal suctioning increased by 13% and NP suctioning decreased by 15% over two bronchiolitis seasons. This recommendation may change when higher quality evidence becomes available.

Literature supporting this recommendation: No citations were found on searches of PubMed or CINAHL on bronchiolitis and deep suctioning. However, 13 citations were located when searching CINAHL searching on just Bronchiolitis and suctioning. Of these articles, two articles are included in this review. Additionally, a QI project conducted at Children's Mercy Kansas informed this review.

Critically Appraised Topic (CAT): Nasal Suction

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.