“When no-one's looking,” the application of lung recruitment and normal saline instillation with paediatric endotracheal suction: An exploratory study of nursing practice

BACKGROUND: Instillation of normal saline before suctioning is a common nursing intervention although little research supports the practice. OBJECTIVES: To determine when and how often saline is used during suctioning and to assess the knowledge of nurses and respiratory therapists of the advantages and dangers of using saline during endotracheal suctioning. METHODS: A survey of nurses and respiratory therapists working in adult ICUs was conducted in a large university teaching hospital. RESULTS: Of the 187 respondents, 96 (51%) rarely instill saline before suctioning, whereas 61 (33%) frequently use saline. Fifty-five percent use saline to enhance retrieval of secretions, and 45% use it to stimulate a cough. Nurses and respiratory therapists differ in their use and understanding of saline instillation. Most nurses (64%) rarely use saline before suctioning, whereas most respiratory therapists (71%) frequently use saline. Respiratory therapists (57%) were more aware than were nurses (37%) of the benefit of using normal saline to stimulate a cough. Nurses indicated more adverse effects of instillation of normal saline, specifically oxygen desaturation and increased risk of pulmonary infections, than did respiratory therapists. CONCLUSION: The results of the survey helped determine target areas for educational programs for nurses and respiratory therapists. A protocol is being developed for use by all who do suctioning.

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Endotracheal saline and suction catheters: sources of lower airway contamination

American Journal of Critical Care ◽

10.4037/ajcc1994.3.6.444 ◽

1994 ◽

Vol 3 (6) ◽

pp. 444-447 ◽

Cited By ~ 57

Author(s):

DA Hagler ◽

GA Traver

Keyword(s):

Critical Care ◽

Normal Saline ◽

Catheter Insertion ◽

Lower Airway ◽

Suction Catheter ◽

Endotracheal Suctioning ◽

Saline Irrigation ◽

Endotracheal Tubes ◽

Viable Bacteria ◽

Saline Instillation

BACKGROUND. Normal saline instillation prior to endotracheal suctioning is a critical care ritual that persists despite a lack of demonstrated benefit. Saline instillation may dislodge viable bacteria from a colonized endotracheal tube into the lower airway, overwhelming the defense mechanism of immunocompromised patients. OBJECTIVE. To determine the extent to which normal saline irrigation and suction catheter insertion dislodge viable bacteria from endotracheal tubes. METHODS. Endotracheal tubes from 10 critical care patients intubated for at least 48 hours were obtained immediately after extubation. Each tube was used in random order for both saline instillation and suction catheter insertion. Dislodged material was cultured for quantitative analysis. RESULTS. Suction catheter insertion dislodged up to 60,000 viable bacterial colonies. A 5-mL saline instillation dislodged up to 310,000 viable bacterial colonies. CONCLUSIONS. The potential for infection caused by dislodging bacteria into the lower airway is additional evidence that routine use of saline during suctioning procedures should be abandoned.

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Normal saline instillation before suctioning: helpful or harmful? A review of the literature

American Journal of Critical Care ◽

10.4037/ajcc1995.4.4.267 ◽

1995 ◽

Vol 4 (4) ◽

pp. 267-271 ◽

Cited By ~ 38

Author(s):

SJ Raymond

Keyword(s):

Normal Saline ◽

Research Utilization ◽

Research Literature ◽

Scientific Data ◽

The Body ◽

Endotracheal Suctioning ◽

Common Clinical Practice ◽

Saline Instillation ◽

Recommended Guidelines ◽

Research Studies

This research utilization paper reviews the body of published literature on the practice of normal saline instillation before endotracheal suctioning of mechanically ventilated adult patients. Although normal saline instillation before suctioning is a common clinical practice, the research literature does not demonstrate any physiologic benefit to this procedure. Moreover, normal saline instillation may decrease oxygen saturation values (via pulse oximetry) after suctioning. The relevant research studies have been inconsistent and inconclusive because of limitations in sample size and research methodology. Further research studies using larger, more diverse samples, adhering strictly to recommended guidelines for endotracheal suctioning, and examining additional physiologic parameters of oxygenation are necessary. In addition, long-term outcomes of normal saline instillation such as respiratory infection and complications, as well as atelectasis, should be evaluated. Until scientific data can be presented to support the physiologic benefit of this practice, normal saline instillation should be discontinued as a routine or standard practice.

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