Endotracheal saline and suction catheters: sources of lower airway contamination

1994 ◽  
Vol 3 (6) ◽  
pp. 444-447 ◽  
Author(s):  
DA Hagler ◽  
GA Traver

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.

1998 ◽  
Vol 7 (4) ◽  
pp. 255-260 ◽  
Author(s):  
D Schwenker ◽  
M Ferrin ◽  
AG Gift

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.


1995 ◽  
Vol 4 (4) ◽  
pp. 267-271 ◽  
Author(s):  
SJ Raymond

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.


2015 ◽  
Vol 30 (4) ◽  
pp. 762-767 ◽  
Author(s):  
Hatice Ayhan ◽  
Sevinc Tastan ◽  
Emine Iyigun ◽  
Yagmur Akamca ◽  
Elif Arikan ◽  
...  

2012 ◽  
Vol 56 (3) ◽  
pp. 312
Author(s):  
Tumul Chowdhury ◽  
Hemanshu Prabhakar ◽  
Navdeep Sokhal

1996 ◽  
Vol 5 (3) ◽  
pp. 192-197 ◽  
Author(s):  
MJ Grap ◽  
C Glass ◽  
M Corley ◽  
T Parks

BACKGROUND: Despite a large number of studies on endotracheal suctioning, there is little data on the impact of clinically practical hyperoxygenation techniques on physiologic parameters in critically ill patients. OBJECTIVE: To compare the manual and mechanical delivery of hyperoxygenation before and after endotracheal suctioning using methods commonly employed in clinical practice. METHODS: A quasi-experimental design was used, with twenty-nine ventilated patients with a lung injury index of 1.54 (mild-moderate lung injury). Three breaths were given before and after each of two suction catheter passes using both the manual resuscitation bag and the ventilator. Arterial pressure, capillary oxygen saturation, heart rate, and cardiac rhythm were monitored for 1 minute prior to the intervention to obtain a baseline, continuously throughout the procedure, and for 3 minutes afterward. Arterial blood gases were collected immediately prior to the suctioning intervention, immediately after, and at 30, 60, 120, and 180 seconds after the intervention. Data were analyzed with repeated measures analysis of variance. RESULTS: Arterial oxygen partial pressures were significantly higher using the ventilator method. Peak inspiratory pressures during hyperoxygenation were significantly higher with the manual resuscitation bag method. Significant increases were observed in mean arterial pressure during and after suctioning, with both delivery methods, with no difference between methods. Maximal increases in arterial oxygen partial pressure and arterial oxygen saturation occurred 30 seconds after hyperoxygenation, falling to baseline values at 3 minutes for both methods. CONCLUSION: Using techniques currently employed in clinical practice, these findings support the use of the patient's ventilator for hyperoxygenation during suctioning.


1987 ◽  
Vol 62 (5) ◽  
pp. 1860-1864 ◽  
Author(s):  
M. K. Witte ◽  
W. A. Carlo

Inspiration is strongly inhibited by volume-related vagal afferents in human neonates and animals, but this reflex is not as active in human adults during normal breathing. To determine whether volume-related inspiratory inhibition occurs beyond the neonatal period, we performed 10 +/- 1 end-expiratory occlusions in nine asleep children, ages 2–29 mo, with cuffed tracheostomy or endotracheal tubes in place. Airflow, tidal volume, occlusion pressure, and surface diaphragm electromyogram (DIA EMG) were simultaneously recorded. Occlusion consistently increased mechanical (P less than 0.002) and neural inspiratory times (P less than 0.001). During occluded respiratory efforts, peak amplitude of DIA EMG increased by 22 +/- 10% (P less than 0.002). In contrast, initial rate of rise of DIA EMG did not change. We conclude that in children with isolated lower airways, end-expiratory occlusions prolonged inspiratory duration as measured by both mechanical and neural parameters. The lack of an associated increase in rate of rise of DIA EMG strongly suggests that inspiration is prolonged by release of volume-related inhibition of inspiration rather than by facilitation. These data provide evidence for the presence of the Hering-Breuer reflex beyond the neonatal period.


2018 ◽  
Vol 31 (2) ◽  
pp. 123
Author(s):  
J. Schults ◽  
M. Cooke ◽  
D. Long ◽  
A. Schibler ◽  
M. Mitchell

Sign in / Sign up

Export Citation Format

Share Document