The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts


K. Boyle, MS, RRT, M. Ayers, BS, RRT Arkansas Children's Hospital, Little Rock, AR

Background: Clinical practice guidelines for bronchiolitis all agree that suctioning is a necessary component of treatment in infants with bronchiolitis. However, in our institution frequent nasopharyngeal suctioning caused trauma and increased nasal edema in some patients. To our knowledge, there is no literature on appropriate methods for frequent suctioning of the upper airway. Other children's hospitals were surveyed to determine what devices they were utilizing in infants with bronchiolitis. All options offered have been tried at one time or another in our institution. The purpose of this bench study was to determine which device suctioned the greatest volume at a constant suction pressure of 80 cmH2O, which is a moderate level of suction pressure for infants.

Suction devices to be evaluated were: the Baby Booger Grabber (BBG) from Children's Medical Ventures, a small yankeur made by Argyle (Y(sm)), a large yankeur made by Baxter (Y (lg)), 6 Fr, 8 Fr, and 10 Fr suction catheters from Medline and a tuberculin syringe (TB) from B-D. We prepared honey/water mixtures in two dilutions (200-ml water to 200-ml honey and 200-ml water to 300-ml honey); we also tested the devices with water. The vacuum pressure was set at 80 cmH2O. Continuous suction was used for each device since two of them (Y(lg) and TB) did not have a suction control port to allow intermittent suctioning. We allowed each device to aspirate the solution for 20 seconds. Three of each device was used and the mean volume was calculated.

Results: Volumes are in milliliters.

Device Water 200 ml Water to 200 ml Honey 200 ml Water to 300 ml Honey
BBG 387 ± 32 232 ± 18 150 ± 8
Y(sm) 591 ± 40 238 ± 10 169 ± 6
Y(lg) 570 ± 22 236 ± 4 182 ± 6
6 Fr 29 ± 5 5 ± 0 4 ± 1
8 Fr 88 ± 4 16 ± 4 12 ± 4
10 Fr 142 ± 18 41 ± 2 21 ± 0
TB 151 ± 24 99 ± 37 67 ± 6

Experience: It has been the experience at our institution, that repeated nasopharyngeal suctioning with a suction catheter may cause trauma (increased bleeding) or increased edema in the infant airway. Since infants are typically nasal breathers, this may result in an increase in the infants' work of breathing. Clinical staff members do not agree on the appropriate method to suction the upper airway without utilizing nasopharyngeal suctioning. The Bronchiolitis Pathway suction instructions should be reviewed and updated to reflect suctioning techniques that can be utilized on a frequent basis (every 30 to 60 minutes the first 12 to 24 hours) to maintain an open nasal airway for these infants.

The devices, which aspirated the greatest volumes, were the Y (lg), Y(sm) and BBG. Y (lg) is too large to fit into the nare of an infant and so would not be an appropriate device for our purposes. The Y(sm) and BBG suctioned the greatest volume at a constant suction pressure of 80 cmH2O. Both devices are small enough to fit into the nare of an infant. This study suggests that the BBG and Y(sm) are effective devices for use in infants, allowing clearance of the upper airway without causing trauma or edema to the nasal conchae or nasopharynx.