You are just starting out your mid-January evening shift, and you go to the room of an 8-month old male with nasal congestion. He is afebrile, and mildly tachycardic, but his lung exam is fairly benign and he’s breathing easily without retractions. You can clearly see he has congestion. You instruct the parents to use saline irrigation and then nasal suctioning to clear the congestion as needed, and they say, “How can we do this if our child struggles? Won’t we just end up with a wet, angry, and congested child?”

The Problem

Infant nasal congestion is a common problem in a winter Emergency Department. Saline irrigation is a cornerstone of URI/viral syndrome management in children from ages 3 months to 1 year old [1]. These children are too young for most medications for symptoms, and antibiotics are not indicated for the vast majority of these patients [2]. Thus, in general, nasal saline irrigation is one of the primary home care instructions we give, and when parents are able to administer it they generally they find it helpful [3]. However, parents are often hesitant about the practicalities of actually administering this therapy [4].

Trick of the Trade: Magical saline irrigation system

Figure 1. Necessary components to create an easy-to-use saline irrigation system

Connect an angiocath tip to a J-Loop, and then attach directly to a saline flush.

Figure 2. Saline irrigation system after set-up completion

Connect these together, and now you have a system which you can use to direct the saline into the nostril of a struggling infant. Hold the base of one hand against the patient’s cheek, and with two fingers direct the angiocath tip into the nostril. With the other hand, you hold the flush.

Use your left forearm to hold down the baby’s right arm, and your right forearm to hold down the baby’s left arm, preventing the patient from pushing things out of the way.

This setup makes saline irrigation much more effective and easy. This method only uses a small amount of saline, and gets the child much less wet and irritated. As a parent using this on my own child, I noted that my kid went back to sleep more quickly because I didn’t have to change him out of saline-soaked clothes. I wasn’t scared of poking him in the eye with the syringe or hurting his nares with hard plastic, so I was much less anxious about administering this therapy.

Conclusion

The setup of saline syringe, J-Loop and angiocath allows for much easier nasal saline instillation into the nares of a struggling infant. It is worth considering sending parents of such children home from the ED with this setup to help facilitate saline irrigation at home.

References

  1. King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2015;(4):CD006821. PMID: 25892369 
  2. Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. Am Fam Physician. 2012;86(2):153-159. PMID: 22962927
  3. Krugman SD, Bhagtani HR. Parental perception of the effectiveness of treatments for nasal congestion. Clinical Pediatrics. 2012;52(8):762-764. PMID: 22399567
  4. Jeffe JS, Bhushan B, Schroeder JW. Nasal saline irrigation in children: a study of compliance and tolerance. Int J Pediatr Otorhinolaryngol. 2012;76(3):409-413. PMID: 22266167
Kavita Joshi, MD

Kavita Joshi, MD

UT Southwestern Medical Center
Assistant Professor of Emergency Medicine
Medical Simulation
Kavita Joshi, MD

Latest posts by Kavita Joshi, MD (see all)