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by NICU_Nurse

Hey, y'all! I was wondering what your policy is regarding the use of saline tubes/bullets for sx'ing a vented baby? I'm hearing word that the head of our respiratory team is telling all of the new orientees not to use them. I have been taught to use them since day one, and honestly, after I heard this news I attempted a few times to sx without the saline and had crappy results. Dry sx'ing just did NOTHING to clear the tubes- try as I might. I had to go down more times, thus prolonging the whole experience for the baby, and STILL didn't get anything out! Sats dropping, baby getting restless...finally just resorted to using the saline like I had been doing before. I was reading the trach thread on another forum here and saw this mentioned by someone else- what do you do, and how do you feel about this if this is to become the new standard? Thanks for your input! As usual, I'm grateful for your opinions. ;>)

[PediRN]

There are different schools of thought and variable research out there to both support and refute the use of saline. Supposedly, the saline forces the secretions further down the trachea, causing pneumonias.
Question: If they are dry, why are you suctioning them? What I find is that babies are suctioned way too much, causing irritation and distress. Usually, regular Chest PT will bring up most of the secretions.
Hope this helps

[KRVRN]

We have no policy on it, supposdely we aren't supposed to do it but some people do and some don't. It ends up being a personal decision, which is absolutely not research based. I don't use them.

[canoehead]

When I did PICU about 5y ago we suctioned every 2 hours no matter what, with the idea that secretions were building up and needed to be removed BC lack of ability to cough when an infant was paralyzed. But they suctioned even non paralyzed infants Q2H. (???) Do you still suction on a schedule, whether the child sounds wet or not?

[Heather333]

I usually only do it if the baby has very thick secretions that are hard to suction. Otherwise, I don't use it. I only suction when necessary not on a schedule.

Heather

[dawngloves]

No, we are not suppsosed to and some RTs don't. But I will if I know the baby has thick secretions. I only suction PRN unless orderd otherwise. Why suction someone who doesn't need it? I know nurses that suction Q3 just because. Well you are opening up to infection and trauma because..??

[nell]

After reading about not using saline on a prior thread, I tried not using it at all but found it is like everything else: it requires judgement. I don't use it for thin secretions, but if they're thick or the baby is desatting and I'm getting nothing with sxn, then I do. Does anyone suction on a schedule anymore?

[prmenrs]

I would suction q6h just to see if the tube is patent--just one pass unless snot was obtained.

I read something about the 1st of the year that made me change my practise, and NOT use saline--it can paralyze the cilia, which impedes the mucociliary action, you never get all the saline back, so then the baby has to deal w/it, i.e., absorb it via the alveoli, wind up w/extra NS in the circulation, might be significant for some kids.

I find it difficult to deal w/change a lot, but what I read convinced me, and I actually advocated for a policy change. They did change the policy and proceedure, so I guess that article convinced others as well.

[NICU_Nurse]

I agree with what many of you have said. Our unit sx's PRN, but thr RT's have a tendency to Sx prior to obtaining gases, which can be as often as q 1-2 hrs. I have found, so far, that dry sx'ing absolutely does not work on larger plugs, and only works if the secretions are truly thin or frothy.

[NicuGal]

We only suction PRN. RDS is not a mucus producing disease, so those kids usually don't need suctioned very often. Of course we have those ones that need it every 2 hours because they are full of ick! We only use saline if the first pass shows really thick stuff. prmnrs is right..it can paralyze the cilia.