Looking after your child's nasal stents

This page explains about looking after your child's nasal stents and what to expect when your child comes to Great Ormond Street Hospital (GOSH).

Nasal stents are thin, plastic tubes inserted into your child’s nostrils after they have had a nose operation. They work by keeping the nostrils open while they heal, so that your child can breath easily.

They are often used after babies have had an operation to correct choanal atresia or piriform aperture stenosis, both of which mean that the nostrils are narrowed or blocked making it hard to breathe.

The stents hold the nostrils open allowing air to pass up the nose and into the windpipe easily. This is very important as babies tend to breathe through their nose rather than their mouth until they are about six months old.

The surgeon inserts the stents into the nostrils towards the end of the operation and keeps them in place with stitches. There will be two tubes hanging a short way out of your child’s nostrils.

After the operation, the nurses will use suction to clear the stents of mucus every 30 minutes or so. As your child is recovering, the nurses will teach you how to look after the stents yourself, so that you are ready to go home.

Stents are the safest way of keeping your child’s nostrils open while they heal, but they will need careful looking after in the months after the operation.

If the stents are too large, they can stretch the nostrils and cause sore and damaged areas. If the nose becomes sore, the stents might need to be replaced in another operation. There is a slight risk of infection but this is greatly reduced by cleaning the area carefully as taught.

The stents need to be kept clean and unblocked so that your child can breathe easily. The nurses will teach you how to recognise when your child needs the stents clearing and to use suction to do so.

As a general rule, you should suction before each feed, when you can see mucus draining from your child’s nose and if they are having to work harder at breathing.

Looking after the stents will seem daunting to begin with, but remember that there is always someone on the end of a telephone at Great Ormond Street Hospital or in your local area to help you.

• Collect all the equipment you need:
  • suction unit
  • catheter
  • connecting tubes
  • syringe of saline
  • bowl or bottle of tap water to flush the tube
• It is a good idea to have a new suction catheter (in its packet) attached to the tubing from the suction pump, in case you need to suction in a hurry and to ensure that the pump is ready to be used at all times.
• Wash your hands, although if suction is needed in a hurry this could be impractical.
• Turn on the pump and check the pressure as instructed.
• Put 0.5ml saline into one stent using the syringe.
• Gradually insert the catheter into the stent, with your thumb off the side port of the suction catheter. The distance you insert the catheter depends on the length of the stent; we will tell you this before you go home.
• Apply suction by covering the side port with your thumb, and slowly withdraw the catheter. This should only take a few seconds.
• Put another 0.5ml of saline into the other stent using the syringe.
• Gradually insert the catheter as before.
• Apply suction for a few seconds while withdrawing the catheter.
• Repeat suction until the stents are clear.
• Disconnect the catheter from the tubing and dispose of it safely. Clear the tubing by suctioning a small amount of water through it. Attach a new catheter ready for next time.

The area around your child’s nose will need cleaning every day and more often if they have a cold. This will clear away any dried mucus and make your child more comfortable.

• Collect all the equipment you need:

• Gently pull the stents forward and backward to loosen them from the inside of the nostrils as you have been taught.
• Dip a gauze square or cotton bud into the water and gently clean off any dried mucus or crusts.
• Check the area around the stents. If any areas look a bit sore, put a thin layer of Vaseline® around the stents and nostrils, taking care not to get any on the ends or inside of the stents.
• Leave to dry naturally.

Call your GP as your child may need antibiotics.

Put another 0.5ml saline into the stent using the syringe and try to insert the catheter again. If you cannot get the catheter into the stent, take your child to the nearest Accident and Emergency (A&E) department.

Contact the ward for advice.

Contact the ward for advice.

Take your child to the nearest Accident and Emergency (A&E) department.

You will need to put saline into your child’s nostrils and suction more frequently and for longer to keep the stents clear. Use only 0.5ml each time and keep repeating as needed.

Use the alternative suction pump you have been lent. Contact local services on the number you have been given to arrange for it to be mended.

The stents will need to stay in place for up to three months after the operation to make sure the nostrils heal properly and stay open to allow your child to breathe easily. They will be removed in a short operation under general anaesthetic lasting about half an hour.

Your child will need to stay in hospital overnight after the operation, but if they have recovered from the anaesthetic and are breathing easily, you will be able to go home the following day.