Use of saline in endotrachial suction

[salmi]

When doing endotracheal suctioning for intubated patient:

Some people say we need to use saline. Others say we should not use saline. Which one is better and why?

[Rileycat]

In school I was taught to NEVER use saline for any type of suctioning (except for suctioning of the nares). However, during my preceptorship in PICU, many of the veteran nurses used saline while suctioning trachs. I never saw anyone use saline to suction an intubated patient. I guess you would have to read your institution's policy and procedure manual to see what is acceptable.

[Jenny P]

Okay, I voted before I read the whole question. I said "yes" because I thought you were talking about saline vs. sterile water for rinsing the catheter. Now I've read the question and first 2 answers, and I see you probably meant do you INSTILL saline into an ET tube to suction. Is that what you meant? If so, I only instill saline into an ETT when the secretions are very dry and sticky and are sticking to the ETT (and possibly narrowing the airway even more) in order to loosen it from the tube. I have also used it to stimulate a cough at times. Instilling saline into the ETT to thin secretions or to make them more mobile is an old nursing idea that research has proven does not work the way we thought it did. And considering I've been doing ET suctioning since way back when we used the same old red french catheter for the whole day (in clean wax cups each shift), I used to use saline in the tube quite often.

My original "yes" was because using sterile water on the catheter to clear the secretions from the tube could be very irritating to the airway tissues even if you only get a tiny drop or 2 of H2O (from rinsing the cath) on the trachea tissues.

[hoolahan, ASN, RN]

Guilty! I used to do this b/c it was the accepted standard. However, this was also in the days when we suctioned q2h regardless of whether they needed it or not.

Then I read an article, it was either in critical care nurse mag or heart and lung, can't remember which, but it was research done on pt's perceptions on suctioning. Pt's described this as the most horrible feeling , particularly when the saline was instilled. The way the article was written, it truly made you feel their pain. I never instilled saline again unless secretions were truly too thick, and there was a clear danger of tube obstruction.

[PhantomRN]

If the secretions are thick I use saline. The end result is that I clear their airway and help them ventilate better.....ABC's

[frann]

How do you clear the plug if you don't use saline?

[salmi]

Hi...Please read from para. 7 in this web page

http://www.harcourthealth.com/Mosby/Wong/hcom_wong_w23.html

Thanks........Salmi