Appendix 15. Clearing of the nasopharynx (nasal irrigation)

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    Nasal irrigation is indicated in children with breathing difficulties due to upper airway obstruction from secretions. It should be performed one hour before or after a feed or a meal if possible. There are two methods: the instillation method and the volumetric method.

    15.1 Instillation technique (done by parents, at home)

    – Wash hands.
    – Lay the child on his back.
    – Instil 2 to 4 drops of normal saline in each nostril when the child inhales.
    – Raise the child (to a semi-seated position) and collect the secretions from the nose and mouth with a tissue.
    – Wash hands.

    15.2 Volumetric technique (done by care provider at an outpatient visit or in the hospital)

    – Wash hands.
    – Lay the child on his back, head slightly elevated.
    – Placing one hand under his neck, turn his head to the right to treat the left nostril.
    – Insert the dropper tip of the normal saline vial at the opening of the left nostril.
    – Squeeze the vial when the child inhales.
    – If the child coughs, stop the instillation and let him settle down for a few minutes.
    – Check that the saline and secretions have drained via the right nostril.
    – Raise the child’s head slightly so that the fluid can drain more easily.
    – Collect the secretions.
    – Repeat the procedure on the other side.
    – Monitor the child for a few minutes after the procedure.
    – Wash hands.