Bronchiolitis is the most common cause of lower respiratory tract infection in the first year of life, and respiratory syncytial virus (RSV) is the most common causative pathogen (60–85% of cases) (Da Dalt et al., 2013). RSV is an inflammation of the lower respiratory tract, specifically targeting the small airways and leading to necrosis and sloughing of the airway lining cells, edema, increased mucous production and bronchospasm (Budhiraja et al., 2012). Due to the inflammation, children with bronchiolitis suffer from hypoxia, difficulty feeding and respiratory distress. Most patients can be easily managed at home, but some require additional interventions such as supplemental oxygen, frequent nasal suctioning, intravenous (IV) fluids, and/or nasogastric tube feeds. The incidence of bronchiolitis during the first year of life has been reported to be 11–15% (Justice & Le, 2022), with hospitalizations occurring for five of every 1000 children <2 years of age (Justice & Le, 2022). The clinical and economic burden of bronchiolitis continues to grow and significantly impacts healthcare, families and communities (Rodriguez-Martinez & Sossa-Briceno, 2022). Several studies have identified barriers to discharge such as hypoxia, frequent deep suctioning, parental discomfort, respiratory distress, poor feeding and provider practice variation from the emergency department (ED) (Stollar et al., 2016).

The American Academy of Pediatrics (AAP) practice guidelines on bronchiolitis do not support routine deep suctioning of the posterior pharynx or larynx (American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis, 2006, Ralston et al., 2014, Silver and Nazif, 2019) due to complications related to deep suctioning such as irritation, swelling and bleeding. The AAP does support suctioning of the nares to provide temporary relief of nasal congestion. Other published guidelines recommend superficial suctioning to clear the nostrils of secretions to improve airway patency, particularly in younger infants (Da Dalt et al., 2013). The rationale behind nasal suctioning is that young infants are nose breathers and nasal secretions impair their ability to breathe and feed. Poor feeding and respiratory distress lead to hospitalization (Jarvis et al., 2014). Preventing or reducing the degree of symptoms mentioned above could decrease admission related health care costs due to bronchiolitis which have been estimated at $734 million/year (Fujiogi et al., 2019).

Nasal suctioning is widely practiced, even though the role of a suctioning device in the management of bronchiolitis has not been studied extensively (Mussman et al., 2013). The current standard of practice for suctioning an infant or child hospitalized with bronchiolitis at an urban tertiary-care freestanding pediatric hospital includes a bulb syringe, a NeoSucker and/or a deep suction catheter as needed. Superficial nasal suctioning/aspiration is performed with the bulb syringe and/or NeoSucker. The bulb syringe can be used by the bedside caregiver, registered nurse (RN), or respiratory therapist (RT). The NeoSucker requires wall suction and can only be used by the RN or RT. Nasopharyngeal suctioning or “deep” suctioning via a catheter is performed exclusively by either the RN or RT and requires wall suction as well. Ringer et al. (2020) found that nasopharyngeal suctioning, a type of suctioning classified as “deep” suctioning removed >36% of sputum mass compared to nasal aspiration. The potential complications of nasopharyngeal suctioning in comparison to nasal aspiration include hemodynamic instability, mucosal trauma, pneumothorax, prolonged coughing during the procedure, bleeding and cross infection (Gomes et al., 2016); hence routine deep suctioning is not recommended.

The suction controlled nasal aspirator was developed by Benincaso and Smith in 1973 to aspirate nasopharyngeal secretions (Benincaso & Smith, 1973). Since then, several nasal suction/aspiration devices have been developed and are available on the market. Suctioning can be done by bulb syringe devices, nasal aspirators and suction catheters connected to pressure devices (Moore, 2003). A prospective observational study conducted in Italy (Casati, Picca, Marinello, & Quartarone, 2007) to examine the safety, efficacy and parental satisfaction of the Narhinel nasal aspirator concluded that the nasal aspirator improved sleep, feeding and respiration. There have been some reports of minor nasal bleeding from these devices (Casati, Picca, Marinello, & Quartarone, 2007; Wai et al., 2007). Nasopharyngeal aspiration has been found to be well tolerated when done to collect samples for respiratory viral testing in the emergency department (Wai et al., 2007). The NoseFrida is a superficial nasal suctioning/aspiration device that has not yet been studied. The device can be purchased from multiple stores and does not require a prescription or specific training. The NoseFrida may be a useful alternative to the NeoSucker due to its similar design and suction capability. If the NoseFrida is comparable to the NeoSucker this may offer another option and one that promotes patient and family centered care. Providing the bedside caregiver with a helpful tool to clear their child's nose will enhance feeding and ease of breathing for their hospitalized infant. Due to its noninvasive design the NoseFrida can be used as often as necessary to clear the nares. An effective suctioning device given to the bedside caregiver has the potential to support both the RN and RT in balancing very busy patient loads, and provides an alternative to the bulb syringe for home use upon discharge.