Normal Saline Instillation in Endotracheal Suction

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Table of Contents

Introduction and general background on the clinical issue
Review of evidence
Analysis of conflicting views
Recommendation
Conclusion
References

Introduction and general background on the clinical issue

The use of normal saline (NS) has been so wide in clinical practice during the process of endotracheal and tracheal suction. This is because clinicians have over the years believed that Normal saline is very effective during the suction process in a number of ways. According to Smith (2007), “the use of a nasal saline flush solution is an alternative procedure that has been associated with fewer side effects in premature infants”.

A number of literature on the use of NS during endotracheal and tracheal suction have also demonstrated mixed reactions as regards its merits and demerits. The clinical issue in the application of normal saline is that even though it is widely used in the process of endotracheal and tracheal suction, available literature point to the fact that it is not a clinically good idea (Puchalski, 2007).

Review of evidence

In the last two decades, numerous research articles, literatures and studies that have been conducted on the physiological effects of NS have abided in a number of issues that buttress that fact that the application of normal saline in endotracheal and tracheal suction is not a clinically good idea. Puchalski (2005) reports that most patients who went through the suctioning process reported excruciating pain and warns that such a process should be performed thought and discretion. Punyoo (2007) has also echoed his concern after an analysis of results retrieved from “quasi-experimental research examined a comparison of the effects of endotracheal suctioning with and without normal saline instillation on physiologic changes in pediatric patients with mechanical ventilator” by stating that the dangers of hypoxia, increase in end tidal CO2, heart rate and blood pressure are as a result of the instillation of normal saline before endotracheal suctioning. Waisman (2006) undertook research on the recovery of sputum in volume and weight during the process of endotracheal and tracheal suction and abide in the conclusion that there was no significant changes especially increase in sputum recovered with suctioning. In the sputum recovery that involved the radioactive labeling of Normal Saline, the observation was that NS moved near to the bottom part of ET (Endotracheal Tube). This means that it does not mix with the secretions. Waisman, (2006), further explains “that the rapid absorption of NS during suctioning illustrates that NS and secretions do not mix”.

Analysis of conflicting views

The conflicting view that dominates this clinical issue is that even though most research works abide in then fact that application of normal saline in endotracheal suctioning is clinically not good, there is increase in its application and its becoming more popular. Jongerden, Rovers, Grypdonck and Bonten (2007) project the conflicting view that instead of exploring other clinically safer suctioning process, closed suction systems are replacing open suctioning systems while still making wide use of normal saline. Venes (2005), Kinloch (2009) and Punyoo (2007) all agree that the endotracheal suctioning is increasingly being undertaken by the application of normal saline but proceed to jointly conclude in the summary and recommendations of their research works that it is not a clinically good idea.

A clear but conflicting view is well illustrated by Halm and Krisko-Hagel (2008) in stating that major clinical institutions continue to recommend the application of normal saline in endotracheal suctioning even with the knowledge of its negative effects on patients. Punyoo (2007) reveal that the use of NS has a chance of increasing the levels of HR (Heart Rate) and may interfere with the levels of BP (Blood Pressure) or RR Respiratory Rate). In addition to the above, Jongerden, Rovers, Grypdonck and Bonten (2007) and Venes (2005) both state that the increase in coughing that comes as a result of the application of NS has the capacity to lead to other detrimental side effects.

Recommendation

In recommendation, the evidence based practice proposes that NS comes along with demerits in the form of adverse effects and as such should not be made use of regularly in the process of endotracheal and tracheal suction. Due to the fact that NS and secretions do not mix, the way to effectively manage the thick secretions during this process and prevent mucus plugs is through “humidification that involves the application of adequate systematic hydration and passive or active humidification for ventilated patients”. Furthermore, mucolytic agents are also applicable.

It is necessary to wash hands well to avoid infection during the opening of NS vials. According to Kinloch (2009), “instillation of normal saline before endotracheal suctioning has an adverse effect on oxygenation as indicated by mixed venous oxygen saturation.” This remains in contradiction to a common assumption in the clinical field that normal saline has the effect of improving the oxygenation levels.

A number of factors must be taken into consideration in the use of NS. These include a long list of clinical preparations that are aimed at undertaking the process successfully and minimizing the amount of pain on the patient. As Venes (2005) points out;

Patients who are unable to breathe through their mouths, inability to clear the nasopharyngeal passage may result in inadequate airflow to the patient’s lungs, reducing blood oxygen saturation and possibly leading to cardiopulmonary arrest and premature infants and other vulnerable patients may develop bradycardia, cardiac arrhythmias, and/or cardiac arrest as adverse effects of nasopharyngeal suctioning.

I therefore support against the routine use of normal saline during the process of endotracheal and tracheal suction and advocate for more research.

Conclusion

The referenced scholarly works for the project avail cross cutting alternatives as to of NS in the process of endotracheal and tracheal suction due to the above literature. In this research paper, it is obvious to propose an alternative consideration to the application of NS. This fact is buttressed by Halm and Krisko-Hagel (2008) in stating that ‘these studies provide evidence of the adverse physiological effects of NS and therefore, support against the routine use of NS with endotracheal/tracheal suctioning”. The examination of the above presented facts and articles on the application of Normal Saline in clinical practice during the process of endotracheal and tracheal suction; it is obvious that regular use of NS is not preferred and as such future health practice must reduce and eventually do away with the use of normal saline.

References

Halm, A. M. and Krisko-Hagel, K (2008). Instilling Normal Saline with Suctioning: Beneficial Technique or Potentially Harmful Sacred Cow? American Journal of Critical Care.

Jongerden, I. P., Rovers, M. M., Grypdonck, M. H. and Bonten, M.J. (2007). Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis. Eijkman-Winkler Centre for Medical Microbiology, University Medical Center Utrecht.

Kinloch, D. (2009). Instillation of normal saline during endotracheal suctioning: effects on mixed venous oxygen saturation. American Journal of Critical Care, Vol 8, Issue 4, 231-240.

Puchalski, M. L. (2005). Should Normal Saline be Used When Suctioning the Endotracheal Tube of the Neonate? Medscape.

Punyoo, J. (2007). A Comparison of the Effects of Endotracheal Suctioning with and without Normal Saline Instillation on Physiologic Changes in Pediatric Patients with Mechanical Ventilation. Pediatric nursing, Mahidol University, Bangkok, Thailand.

Smith, N. (2007). Nasopharyngeal Suctioning. , CINAHL Nursing Guide. Nursing Reference Center.

Venes, D. (2005). The use of Normal Saline Instillation in Endo-tracheal suction. Taber’s Cyclopedic Medical Dictionary. Nursing Reference Center.

Waisman, D. (2006). Non-traumatic nasopharyngeal suctioning in premature infants with upper airway obstruction from secretions following CPAP. Journal of Pediatrics, 149(2), 279.

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