@article {8082, title = {Nasal irrigation with saline solution significantly improves oxygen saturation in infants with bronchiolitis.}, journal = {Acta Paediatr}, year = {2015}, month = {2015 Nov 26}, abstract = {

AIM: Published guidelines do not recommend nasal irrigation in bronchiolitis, but it is common practice in Italy, despite a lack of data on its benefits or adverse effects. This single-blind, multicentre, randomised controlled trial compared nasal irrigation using either isotonic 0.9\% sodium chloride or hypertonic 3\% sodium chloride with simple supportive care in infants with bronchiolitis.

METHOD: We randomly assigned 133 Infants up one year of age, who were admitted to the emergency department with bronchiolitis and an oxygen saturation (SpO2) of between 88-94\%, to the isotonic (n=47), hypertonic (n=44) or standard care (n=42) groups. Variations in SpO2 and the wheeze, air exchange, respiratory rate, muscle use (WARM) respiratory distress score were recorded at zero, five, 15, 20 and 50 minutes.

RESULTS: Five minutes after the intervention, the median SpO2 value (95\%) in the isotonic group was higher than both the hypertonic (94\%) and the standard care (93\%) groups. The differences between the isotonic and standard treatment groups were statistically significant at each time point, while the hypertonic group only reached significantly higher values after 50 minutes. However, the WARM score did not improve.

CONCLUSION: A single nasal irrigation with saline solution significantly improved oxygen saturation in infants with bronchiolitis. This article is protected by copyright. All rights reserved.

}, issn = {1651-2227}, doi = {10.1111/apa.13282}, author = {Schreiber, Silvana and Ronfani, Luca and Ghirardo, Sergio and Minen, Federico and Taddio, Andrea and Jaber, Mohamad and Rizzello, Elisa and Barbi, Egidio} } @article {7763, title = {Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial.}, journal = {Arch Dis Child}, volume = {100}, year = {2015}, month = {2015 Jul}, pages = {700-3}, abstract = {

OBJECTIVE: Recent evidence supports the use of normal saline flushes in place of heparin to maintain the patency of peripheral intravenous locks (IVLs); however, there are no data regarding the recommended flush frequency.

STUDY DESIGN: This was an open, non-inferiority, randomised controlled trial. Children with IVLs, aged 1-17 years, were randomly assigned to receive saline flushing every 12 h (group A) or every 24 h (group B). The main outcome was the maintenance of catheter patency.

RESULTS: Four hundred patients were randomised; 198 subjects were analysed in the 12 h group and 199 in the 24 h group (three patients were lost at follow-up). Occlusion occurred in 15 children (7.6\%) in group A versus 9 (4.5\%) in group B (p=0.21). The difference in catheter patency was +3.1\% in favour of the 24 h group (95\% CI -1.6\% to 7.7\%), showing the non-inferiority of the 24 h procedure (the non-inferiority margin was set at -4\%). Catheter-related complications were not different between the two groups (12.1\% in group A vs 9.5\% in group B; p=0.42).

CONCLUSIONS: A flushing procedure with one flush per day allows maintenance of catheter patency without an increase in catheter-related complications. We propose a simplification of the flushing procedure with only one flush per day, thereby reducing costs (materials use and nursing time), labour and unnecessary manipulation of the catheters which can cause distress in younger children and their parents.

TRIAL REGISTRATION NUMBER: The study is registered in the international database ClinicalTrial.gov under registration number NCT02221024.

}, keywords = {Adolescent, Catheterization, Peripheral, Catheters, Indwelling, Child, Child, Preschool, Equipment Failure, Female, Humans, Infant, Male, Outcome Assessment (Health Care), Risk Assessment, Sodium Chloride, Therapeutic Irrigation}, issn = {1468-2044}, doi = {10.1136/archdischild-2014-307478}, author = {Schreiber, Silvana and Zanchi, Chiara and Ronfani, Luca and Delise, Anna and Corbelli, Alessandra and Bortoluzzi, Rosamaria and Taddio, Andrea and Barbi, Egidio} }