we don't use inline suction either. We do suctioning 2-3 hours but i prefer doing it 3-4 hours interval unless the baby has desat and i can hear secretions. When I started my orientation at the NICU, the common practice was to use saline flush to loosen secretions. I had to go online for any EB lit on the use of saline to assure myself that I'm not shoving a foreign body to my baby's lungs. Most research i found though does not recommend the use of saline because it increases the risk for infection and a worsening oxygenation esp if the patient doesn't have a cough reflex. Over the years, I noticed that most of the saline I instill in the ET I don't get back when i suction. (). Naturally, that makes me nervous. I don't routinely use saline nowadays, but when I do, I use 0.5-1ml. Oh, and btw it is routine in our unit to do CPT with all back tapping, vibration and stuff. I was shocked at first especially since most of the RTs working in our hosp are males and they're quite rough so yeah, even if it's annoying to be doing somebody's job, I'd rather not let those RTs touch my baby.