bolusing a trach with ns but not suctioning afterwards

[Happiness08]

has anyone ever heard of bolusing a trach with NS but not suctioning afterwards? it seem to me that this is more harmful than benefical.

[nursecass]

There is actually a great deal of research available saying NOT to do this. Most research shows that infusing an ETT/Trach before suctioning is not beneficial to the patient. It takes longer for the O2 levels to return to normal and does not actually aide in suctioning. (Although I have to say when I get REALLY thick secretions I use saline to make sure I can get it through the opening in the suction tubing-but only after I can't get stuff out the normal way.)

[RN1982]

I've heard that even instilling NS into the trach doesn't change the viscosity of the secretions. It just introduces more bacteria into the trach and lungs.

[nursecass]

I've heard that even instilling NS into the trach doesn't change the viscosity of the secretions. It just introduces more bacteria into the trach and lungs.

I've read that as well, but experience tells me differently. When I started on my unit I was totally against it (due to research findings), but after seeing it work for numerous nurses I am more inclined to do it. Granted though that I think I've only done it maybe a total of 5 times since starting a year ago because I still believe in the research. Only for people with plugs or super thick secretions (usually that have plugged once or twice in last 24 hours) that we just can't get through normal suctioning do I infuse.

And for OP-what was the rational behind infusing and not suctioning? I've never heard of such a thing...

[Happiness08]

Thank you for the rapid response. My concern is that it seems this practice might be used almost daily with NO SUCTIONING following the bolus. The pt is then left to clear the airway himself. I knew it was no longer recommended before suctioning so I was thinking without suctioning it would be even more harmful as the coughing might dislodge feeding tubes beside the possibility of the patient not being able to clear the airway himself. Is NS ever recommended as a bolus to a trach without suctioning is really the question I am asking.

[Elektra6, ASN, BSN, RN]

My patient uses NS bullets before using the coughalator. We don't suction him at all, just pull the secretions out with the coughalator. IMHO when his secretions are thick, the saline just seems to sit on top of them. When you cough him, you just get back the saline you put in.

[Happiness08]

What would you think if the daily practice was to bolus but not use a coughalator afterwards?

[Elektra6, ASN, BSN, RN]

I wouldn't do it. I don't think the secretions would mix with the saline enough to warrant the bolus.

[rehabhereIcome]

FYI and not exactly related. I have a many many years ventilated trached CT and he hates hates hates when nurses automatically put NS down his trache prior to suctioning. Ask your patient first what he typically does. He also finds it burns and feels that the saline just sits there and adds more to his misery.

[leslie :-D]

we don't use ns boluses.

but we will give a bolus of humidified o2 followed by a yankauer cath.

works quite well.

leslie

[NurseyPoo7]

I've never even heard of this, of course I'm new.

[Perpetual Student]

I do it. It struck me kind of odd at first, too, but it seems to help the pt (vented w/ PMV used) be able to clear his secretions. This is in the pt's home with a fairly stable pt who is well-adjusted to his trach, I'd be more leery in someone more likely to get an infection. It's ordered (PRN), he wants it, and he's been doing it for years without a problem, so I'm not going to say no.