Nasal Suction Research Articles

일개 대학의 핵심간호술 18종 프로토콜 개발 연구

Purpose : This study was conducted to establish a core nursing skills and evaluation protocols by modifying and supplementing Programme Outcome of nursing curiculum at a college. Methods : Through quantitative and qualitative surveys, expert consultation, and validity, 18 core nursing skills and evaluation protocols were finally derived. Results : The 18 core nursing skills include vital signs measurement, oral medication, intramuscular injection, subcutaneous injection, intradermal injection, intravenous fluid infusion, transfusion, intermittent gavage nutrition, simple catheterization, indwelling catheterization, enema, peripheral oxygen saturation measurement and electrocardiogram monitor, oxygen therapy using a nasal cannula, suction, basic CPR and defibrillator application, pain control, bedsore management and fall prevention nursing, and drainage management. Conclusion : It is expected that the final completed core nursing skills and evaluation protocols will contribute to improving nursing students’ core nursing skills competency and clinical adaptation ability.

A case report on use of ivermectin as nasal drop in a case of nasal myiasis

We describe a case of nasal myiasis due to in a 52-year-old Hindu priest with a previously known case of right sided hemiparesis with diabetes mellitus. Initial attempts to remove the fly larvae using manual extraction with a toothed forceps and normal saline irrigation were unsuccessful. On subsequent nasal irrigation after instillation of ivermectin tabs crushed in normal saline as nasal drops, the patient self-expulsed some larvae, and rest larvae were cleared on subsequent nasal suction and clearance. He also received a course of oral ivermectin. Here, we propose that the antiparasitic oral tablet ivermectin can be used in a nasal drop formulation for the aid of nasal myiasis.

Intratracheal instillation of budesonide suspension versus normal saline on oxidative stress in neonates with meconium aspiration syndrome

Background Presently, the efficacy of neonatal resuscitation techniques via interventions such as oral, nasal, and endotracheal suction for preventing meconium aspiration syndrome (MAS) after delivery has not been satisfactory. Objective This study aimed to investigate the role of intratracheal instillation of budesonide on oxidative stress in MAS. Methods Sixty-two neonates with MAS admitted to Huai’an Maternity and Child Healthcare Hospital from January 2018 to June 2020 were divided into a study group (intratracheal instillation of 2 ml budesonide suspension; n = 31) and a control group (intratracheal instillation of 2 ml normal saline; n = 31). Collect data from two groups of patients and evaluate clinical outcomes, including oxygenation index (OI), as well as serum total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and 8-Isoprostane before treatment and 72h after admission. Results We found no statistical differences in mortality, complication rate, total oxygen inhalation time, OI before treatment and 72h after admission between the two groups of neonates with MAS, while the duration of invasive respiratory support in the study group was significantly shorter than in the control group. Also, serum TAC, TOS, OSI and 8-isoprostane levels were not statistically different before treatment between the two groups. After 72h of admission, OSI and 8-Isoprostane in neonates with MAS in the study group were much lower than those in the control group. TOS, OSI, 8-Isoprostane in the control group and 8-Isoprostane in the study group were significantly higher than those before treatment. As for TAC and TOS, no significant differences were observed between the two groups. Conclusion Intratracheal instillation of budesonide was shown to alleviate oxidative stress and shorten invasive ventilation time in neonates with MAS.

SG-APSIC1089: Environmental screening of SARS CoV-2 to support an outbreak investigation in Sardjito Hospital, Yogyakarta, Indonesia

Objectives: Many healthcare workers and patients in intensive care units of Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia, were infected with SARS-CoV-2 in June–August 2021, during the second wave of the COVID-19 pandemic. Much evidence has shown that SARS-CoV-2 persists on hospital environmental surfaces and medical equipment. We investigated the potential sources of virus in our cases, particularly environmental contamination. Methods: Environmental screening for SARS-CoV-2 was conducted using RT-PCR of swabs collected from case-related medical equipment and hospital surfaces. We examined the environmental cleaning method in these areas as well. Results: We swabbed medical equipment in close contact with patient droplets such as the ventilator, the high-flow nasal cannula, the nebulizer, and suction equipment, as well as some environmental surfaces near the patient, such as the bed rail, air conditioning unit, and portable HEPA-filter outlet. Among 19 samples, genetic material of SARS-CoV-2 was detected only on a sample from a nebulizer. The point of contamination was on the outer body of that nebulizer, which indicated that the contact transmission source might be from patient droplets and/or inadequate cleaning. No more positive results emerged from our screening, indicating that the environmental cleaning was adequate. The IPC team recommended that we no longer use nebulizers for COVID-19 patients and that the cleaning procedure be improved, particularly after the device is used. Conclusions: Environmental screening for SARS-CoV-2 can be used to support investigations of inpatient COVID-19 outbreaks in hospitals. Adequate cleaning and care procedures for medical equipment are very important in preventing the transmission of SARS-CoV-2 in the hospital setting.

Nasal Suction

Nasal Suction

Efficacy of chemical and electrical cautery (Comparison) in management of Anterior Epistaxis

Objective: To compare the efficacy of chemical versus electrical cautery in the management of patients presenting with anterior epistaxis in terms of frequency of bleeding. Materials and Methods: Study Design = Randomized Control Trial (RCT)Study Setting = ENT Department Benazir Bhutto Hospital, RawalpindiDuration = 6 monthsSampling Technique = Consecutive (Non Probability) A Randomized Control Trial (RCT) of six months was done after the approval of the Ethical Committee. A total of 90 cases of anterior epistaxis were randomly divided into two groups: A (electrical cautery) and B (chemical cautery) using a random number trial with 45 in each group respectively. Informed consent was taken from all patients. Patients were explained about the procedure and its risk-benefit ratio. A detailed history was taken about epistaxis from patients presenting in an emergency. The site of bleeding was assessed. Pulse and blood pressure of patients were monitored. Patients were treated on an emergency basis. The nasal cavity was inspected with the help of a nasal speculum and suction of any blood clots was done. Bleeding points were identified and sprayed with lidocaine. The bleeding area was cauterized with a silver nitrate stick or electrical cautery for a few seconds. Antibiotic ointment was applied at the site of cautery to both groups. The patient was discharged on cessation of bleeding. A Performa was given to patients to fill 48 hours, 1 week, and 2 weeks after the procedure containing questions regarding relief of symptoms. Recurrent bleed was diagnosed on a history of separate bleed from nose post-procedure that was sudden in onset, with an identifiable bleeding point on inspection by speculum, total duration of all episodes in previous 24 hours less than 30 minutes.Results: A total of 90 cases (45 in each group) were taken. The mean age was calculated and found 34.42±8.70 in Group-A and 34.29+8.94 years for group B., The male patients were 32 (71.11%) in Group-A and 30 (66.67%) in Group-B while females were 13 (28.89%) in Group-A and 15 (33.33%) in Group-B, efficacy between chemical and electrical cautery in patients with reference to frequency of bleeding was 42 (93.33%) in Group-A and 35 (77.78%) in Group-B, the p value was calculated as 0.03 which shows a significant difference. Conclusion: This study concluded that the efficacy of electrical cautery is significantly higher than chemical cautery in the management of epistaxis. However, some other trials on larger sample size are required to validate the findings of this study.

Neonate with Respiratory Distress, Bilateral Microtia, Hypocalcemia, and Lymphopenia.

Neonate with Respiratory Distress, Bilateral Microtia, Hypocalcemia, and Lymphopenia.

Effect of nasal suction catheter use on aerosol generation during endoscopic sinus surgery.

Effect of nasal suction catheter use on aerosol generation during endoscopic sinus surgery.

Aerosol and Droplet Risk of Common Otolaryngology Clinic Procedures.

Define aerosol and droplet risks associated with routine otolaryngology clinic procedures during the COVID-19 era. Clinical procedures were simulated in cadaveric heads whose oral and nasal cavities were coated with fluorescent tracer (vitamin B2) and breathing was manually simulated through retrograde intubation. A cascade impactor placed adjacent to the nares collected generated particles with aerodynamic diameters ≤14.1 µm. The 3D printed models and syringes were used to simulate middle and external ear suctioning as well as open suctioning, respectively. Provider's personal protective equipment (PPE) and procedural field contamination were also recorded for all trials using vitamin B2 fluorescent tracer. The positive controls of nebulized vitamin B2 produced aerosol particles ≤3.30 µm and endonasal drilling of a 3D model generated particles ≤14.1 µm. As compared with positive controls, aerosols and small droplets with aerodynamic diameter ≤14.1 µm were not detected during rigid nasal endoscopy, flexible fiberoptic laryngoscopy, and rigid nasal suction of cadavers with simulated breathing. There was minimal to no field contamination in all 3 scenarios. Middle and external ear suctioning and open container suctioning did not result in any detectable droplet contamination. The clinic suction unit contained all fluorescent material without surrounding environmental contamination. While patients' coughing and sneezing may create a baseline risk for providers, this study demonstrates that nasal endoscopy, flexible laryngoscopy, and suctioning inherently do not pose an additional risk in terms of aerosol and small droplet generation. An overarching generalization cannot be made about endoscopy or suctioning being an aerosol generating procedure. 3.

Designing and manufacturing of a user friendly and affordable nasal suction machine for Acute Bronchiolitis treatment of children in Oman

Acute Bronchiolitis is a disease which usually infects children of the age 0 to 6 years old. The patients infected by this disease require medical attention at hospitals. The patients must be admitted in the hospitals for a period of 2-3 days. Parents of the patients must stay in the hospital along with them. This causes lack of hospital beds, more expense of the hospital to provide extra food for the parents. By a qualitative research, it was found that parents would want an affordable device so that they could care for their children from home instead of staying at the hospital. Parents from all over Oman come to the capital so that their children can be treated. Children also tend to get exposed to more sickness by being around sick children at the hospital. Taking this problem into consideration, a circuit has been designed in such a way it was easy to use and that it could be used by parents to treat their children at home without the need to visit a hospital. The circuit works on Arduino Uno and has various pre-existing modules attached to it , the estimated cost of the device is far lesser than what the mainstream industrial devices cost. The device consists of a Bluetooth Module for the purpose of connectivity via cellphone ,a 12V vacuum pump to suck the mucus out of the patient’s lungs, variable resistor to control the force of vacuum and a rubber tube capable of fitting into the nostril to allow suction of mucus. This simple device made from the counter parts can offer significant benefits to patients affected by Acute Bronchitis.

Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia

Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1 700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1)Standard prevention and protection, and patient isolation; (2)Patient wearing mask during HFNC treatment; (3)Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4)Placing filter between resuscitator and mask or artificial airway; (5)For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6)Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O(1 cmH(2)O=0.098 kPa); (7)In-line suction catheter is recommended and it can be used for one week; (8)Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9)For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10)PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11)Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.

Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia

Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1,700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1) Standard prevention and protection, and patient isolation; (2) Patient wearing mask during HFNC treatment; (3) Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4) Placing filter between resuscitator and mask or artificial airway; (5) For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6) Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O; (7) In-line suction catheter is recommended and it can be used for one week; (8) Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9. For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10) PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11) Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.

Effect of nasal suction on reliving feeding difficulty in children affected with bronchiolitis

Background: Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. Although bronchiolitis is a prevalent illness in India, very few studies are performed in India regarding management of bronchiolitis. Supportive care is the mainstay of treatment concentrating on fluid replacement and gentle suctioning of nasal secretions, oxygen therapy, and respiratory support if necessary. Infants affected with bronchiolitis also have feeding difficulty which will lead to dehydration and also increase the severity of disease.Methods: A prospective randomized control study was performed in the department of Pediatrics SSMC Rewa. Nasal suction was performed in 75 patients classified under the case group. Feeding difficulty was assessed before and after the suction for 24 hours.Results: We noted that after the first episode of nasal suction which is at 0th hour feeding difficulty was persisted in most of the patients. The p-value was 0.1148 which is not significant. But from 4th hour till the 16th hour the difficulty in feeding decreased after the nasal suction, and by Chi-square test this improvement was statistically. From 20th hour difficulty in feeding still improved after nasal suction but this change was not statistically significant.Conclusions: Nasal suction is an effective supportive treatment in the patients with bronchiolitis and by its use it improves the feeding in the infants suffering from bronchiolitis.

98. IMPROVING BRONCHIOLITIS MANAGEMENT WITH A CARE PATH

Background Bronchiolitis is the number one cause of hospitalization in children under 2 years of age. AAP guidelines emphasize that only supportive care is needed for bronchiolitis. Data obtained from our institution showed poor adherence to AAP guidelines. This project was undertaken with the goal of improving compliance with these guidelines. Aim Statement Our aim was to reduce length of stay (LOS) for admitted low risk patients with bronchiolitis, age 1-24 months, from 67 hours to Interventions A care path and respiratory score were adapted for our institution. Every patient admitted for bronchiolitis was assessed and given a score using respiratory rate, auscultation, and use of accessory muscles. All patients was ordered nasal suction, saline and reassessed. Persistently high scores resulted in escalation of care. The respiratory score and order set were built into the EMR. The care path was made hospital policy. Physicians, respiratory and nursing received education. Measures Data from patients age 1-24 months hospitalized with bronchiolitis from Nov - Dec 2017 were obtained. Excluded were those born Results Charts of patients with bronchiolitis from Jan to Dec 2018 were reviewed. Data were collected regarding LOS, PICU use, and use of chest x ray, albuterol, steroids, epinephrine and antibiotics. We saw an increase in cases in Sept-Dec 2018 with no increase in PICU use. Nov and Dec 2018 average LOS was Conclusions and Next Steps Conclusions and Next Steps With additional education and reinforcement, we hope to make the trend toward improved care for bronchiolitis the standard in our institution. Early observations after implementation of the care path indicate a reduced length of stay, but further data points are needed to know if this change will be sustained.

Routine oro/nasopharyngeal suction versus no suction at birth.

For the current issue of the Journal, we asked Dr. Manoj Kumar to comment on and put into context the recent Cochrane Review on routine nasal suction at birth. Oro/nasopharyngeal suction is a method used to clear secretions from the oropharynx and nasopharynx through the application of negative pressure via a suction catheter or bulb syringe. Traditionally, airway oro/nasopharyngeal suction at birth has been used routinely to remove fluid rapidly from the oropharynx and nasopharynx in vigorous and nonvigorous infants at birth. Concerns relating to the reported adverse effects of oro/nasopharyngeal suctioning led to a practice review and routine oro/nasopharyngeal suctioning is no longer recommended for vigorous infants. However, it is important to know whether there is any clear benefit or harm for infants whose oro/nasopharyngeal airway is suctioned compared with infants who are not suctioned. The objective of this study was to evaluate the effect of routine oropharyngeal/nasopharyngeal suction compared with no suction on mortality and morbidity in newly born infants.

Effects of tracheal indwelling pipette on blood oxygen saturation and complications in patients with severe pneumonia

Objective To investigate the effect of tracheal indwelling pipette on blood oxygen saturation and complications in patients with severe pneumonia. Methods From December 2014 to December 2016, 68 patients with severe pneumonia in Ji'nan Central Hospital were selected and divided into the observation group and the control group according to the random number table method, with 34 cases in each group.The two groups were given conventional phlegm, anti-infection and other symptomatic treatment.The observation group received suction tube through nasal insertion on the need for suction based on the conventional treatment.The control group received mouth or nasal suction according to the patients' condition at any time based on the conventional treatment.The blood oxygen saturation before and after sputum aspiration were compared in the two groups, the incidence of complications were recorded. Results Before sputum suction, the SpO2, RR in the observation group were (89.5±1.4)%, (31.1±1.5)times/min, respectively, which in the control group were (89.7±1.5)% and (31.2±1.4)times/min, respectively, there were no statistically significant differences between the two groups (t=0.568, P=0.572, t=0.284, P=0.777). After sputum suction, SpO2 was significantly increased in the observation group [(98.4±1.3)%], RR was significantly lower than that before suction[(19.8±2.7)times/min], the differences were statistically significant between the two groups(t=27.163, P=0.000; t=21.333, P=0.000). The SpO2 in the observation group[(98.4±1.3)%] was significantly higher than (90.2±2.6)% in the control group (t=16.448, P=0.000). The overall incidence rate of the complications and mortality in the observation group were 26.5% and 11.8%, respectively, which were significantly lower than 67.6% and 52.9% in the control group (χ2=11.57, P=0.000; χ2=13.17, P=0.000). Conclusion Intravascular retention of suction tube can significantly improve the patients' blood oxygen saturation, reduce the risk of serious complications, and has a positive significance to improve the treatment effect. Key words: Pneumonia; Catheters, indwelling; Sputum; Suction; Saturation of blood oxygen; Complication

Effects of Nasal Suction on Outcome of Bronchiolitis

Effects of Nasal Suction on Outcome of Bronchiolitis

Methicillin-Resistant Staphylococcus aureus Nasal Swab and Suction Drain Tip Cultures in 4573 Spinal Surgeries

A retrospective single-center study. To assess the diagnostic value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab and suction drain tip cultures. The prognostic value of MRSA nasal swab and suction drain tip cultures has not been firmly established in spinal surgery. This study retrospectively included 4573 consecutive patients who underwent spinal surgery between January 2008 and December 2014. Patients diagnosed with infectious disease were excluded. Prophylactic antibiotics were administered intraoperatively and postoperatively for 48 hours. MRSA nasal swab cultures were taken from all patients before surgery. Drains were removed when the volume of postoperative fluid drainage was less than 50 mL in the preceding 24 hours and cultures were made. Surgical site infection (SSI) was defined according to Centers for Disease Control and Prevention criteria. SSI was identified in 94 cases (2.1%) and bacteria were isolated in 87 cases (92.6%). Positive MRSA nasal swab cultures were identified in 49 cases (1.1%). There was no significant difference in the SSI positivity rate between the MRSA nasal swab culture (+) and (-) groups. Positive drain tip cultures were found in 382 cases (8.4%), 28 of which developed SSI. There was a significant difference in the SSI positivity rate between the drain tip culture (+) and (-) groups. The sensitivity of drain tip culture was 29.8% and the specificity was 92.1%. In 16 of the 28 patients in the SSI (+) group with positive drain cultures, the same bacteria were isolated from the surgical site, giving a bacteria matching rate of 57.1%. MRSA nasal swab and drain tip cultures were not useful for predicting SSI. However, drain tip culture had a high positivity rate in the SSI group and the coincidence rate for the causative pathogen was relatively high. 4.

Congenital Bilateral Choanal Atresia: A Rare Case

Congenital Choanal Atresia (CCA) is the developmental misstep or inadequacy of the nasal cavity to connect posteriorly with the nasopharynx. Bilateral atresia presents with life threatening asphyxia at birth, while unilateral variety often remains unnoticed and presents later. This is to highlight the importance of taking into account the bilateral form in differential diagnosis of severe respiratory distress in the newborn. In our case a full term, newborn baby presented with attacks of cyanosis and respiratory distress soon after birth. The insertion of nasal suction catheters in both nasal cavity and its non-passage into oropharynx, confirmed the diagnosis of bilateral Choanal atresia. As surgical repair is recommended at the earliest in bilateral cases thus immediate transnasal endoscopic repair was done relieving the life threatening nasal obstruction.

Congenital basal meningoceles with different outcomes: a case series

BackgroundBasal meningoceles are rare congenital defects and often clinically occult until they result in life-threatening complications. Therefore, it is important to know the diagnostic clues to early diagnosis.Case presentationWe describe three cases of congenital basal meningocele in a 3-year-old Japanese boy, a 1-month-old Japanese baby boy, and a 10-month-old Japanese baby girl. One of our patients died of sepsis due to traumatic rupture of the meningocele during nasal suction. His meningocele remained undiagnosed until it resulted in the fatal complication. The other patients underwent surgical repair without any complications. Their meningoceles were complicated by midfacial anomalies including cleft palate and hypertelorism, or a sign of nasal obstruction such as snoring.ConclusionsThese clinical features may be a clue to the early diagnosis of congenital basal meningocele, which enables its safe preoperative management and provides an opportunity for surgical repair before the condition results in serious complications.