Instillation of normal saline before suctioning in patients with pulmonary infections: a prospective randomized controlled trial. Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia* Effects of normal saline on endotracheal suctioning. Instillation of normal saline before suctioning in patients with pneumonia. Endotracheal saline and suction catheters: sources of lower airway contamination. The standard of suction for patients undergoing endotracheal intubation.
OBJECTIVE To determine the effect of instillation of normal saline before suctioning on oxygen saturation , heart rate , and blood pressure in patients with pulmonary infections . METHODS A prospect i ve r and omized controlled trial was conducted in the surgical , medical , and burn/trauma ICUs of an academic medical center . Eighteen men and 11 women ( mean age = 60 years ) receiving mechanical ventilation who met the criteria for pulmonary infection were r and omly assigned to 2 groups . One group had instillation of a 5-mL bolus of normal saline before suctioning ; the other did not . Suctioning was done as needed during an 8-to 12-hour period . Oxygen saturation , heart rate , and blood pressure were measured noninvasively immediately before and after suctioning , at 1-minute intervals for 5 minutes after suctioning , and at 10 minutes after suctioning . RESULTS Instillation of normal saline had an adverse effect on oxygen saturation , which worsened over time . Differences in saturation between the 2 groups were significant at 4 , 5 , and 10 minutes after suctioning . Differences in heart rate and blood pressure were not significant . CONCLUSION Instillation of normal saline before suctioning has an adverse effect on oxygen saturation and should not be used routinely in patients receiving mechanical ventilation who have pulmonary infection Objectives : To compare the incidence of  ventilator-associated pneumonia ( VAP ) with or without isotonic saline instillation before tracheal suctioning . As a secondary objective , we compared the incidence of endotracheal tube occlusion and atelectasis . Design : R and omized clinical trial . Setting and Patients : The study was conducted in a medical surgical intensive care unit of an oncologic hospital . We selected consecutive patients needing mechanical ventilation for > 72 hrs . Patients were allocated into two groups : a saline group that received instillation of 8 mL of saline before tracheal suctioning and a control group which did not . VAP was diagnosed based on clinical suspicion and confirmed by bronchoalveolar lavage quantitative culture . The incidence of atelectasis on daily chest radiography and endotracheal tube occlusions were recorded . The sample size was calculated to a power of 80 % and a type I error probability of 5 % . Measurements and Main Results : One hundred thirty patients were assigned to the saline group and 132 to the control group . The baseline demographic variables were similar between groups . The rate of clinical ly suspected VAP was similar in both groups . The incidence of microbiological proven VAP was significantly lower in the saline group ( 23.5 % × 10.8 % ; p = 0.008 ) ( incidence density/1.000 days of ventilation 21.22 × 9.62 ; p < 0.01 ) . Using the Kaplan-Meier curve analysis , the proportion of patients remaining without VAP was higher in the saline group ( p = 0.02 , log-rank test ) . The relative risk reduction of VAP in the saline instillation group was 54 % ( 95 % confidence interval , 18%–74 % ) and the number needed to treat was eight ( 95 % confidence interval , 5–27 ) . The incidence of atelectases and endotracheal tube occlusion were similar between groups . Conclusions : Instillation of isotonic saline before tracheal suctioning decreases the incidence of microbiological proven VAP This study was design ed to determine the effects of saline solution administered prior to endotracheal suctioning by nurses working in intensive care on oxygenation , heart rate and long-term pulmonary hygiene . The study was carried out on an experimental basis in the Intensive Care Unit of a university hospital in Turkey . A total of 20 patients were included , who were mechanically ventilated because of pulmonary or cardiovascular problems or trauma . Data were collected using a data form . Each patient was monitored for 5 minutes following suctioning with or without saline solution and findings of heart rate , SpO2 , and blood gas measurements were recorded . Data were analysed using percentage calculations , the student 's t-test and the Friedman test . The study showed that most of the patients were between 60 and 69 years and were intubated because of respiratory insufficiency . Evaluation of blood gases following suctioning with or without saline solution showed partial decreases in pO2 , pCO2 , HCO3 , and oxygen saturation ( SaO2 ) , which did not reach a significant level . No significant difference was found between pH levels recorded prior to and 5 minutes after suctioning without saline solution ; however , the increase in pH following suctioning with saline solution was significant . Patients undergoing suctioning with saline solution exhibited significantly increased heart rates in the fourth and fifth minutes , whereas no increases were detected in these undergoing suctioning without saline solution .  SpO2 values obtained by pulse oxymeter did not show significant differences . Saline solution administered with suctioning result ed in undesirable , although not significant , alterations in oxygen saturation and arterial blood gas levels This study was conducted to investigate the effects of a no saline , a 2 ml and a 5 ml saline instillation prior to endotracheal suctioning on oxygen saturation in patients with pneumonia . The subjects in this study were 16 pneumonic patients with a tracheotomy tube , who had been admitted to the neuro-surgical intensive care unit at a university hospital in Seoul Korea . All three ( 0 , 2 and 5 ml ) saline instillation methods were applied to the 16 patients . The methods were r and omly assigned to each patient . Each of the instillation methods was applied in a four-step sequence : 1 ) recording the  level of oxygen saturation  ( baseline levels ) , 2 ) instilling normal saline , 3 ) supplying oxygen and suctioning , and 4 ) recording the level of oxygen saturation . The oxygen saturation was evaluated using pulse oximetry . The recovery times for oxygen saturation to return to baseline levels following suctioning were , just after suctioning , 45 seconds after suctioning and in excess of 5 minutes with 0 , 2 and 5 ml saline instillations , respectively . Instillation of normal saline before suctioning could have an adverse effect on oxygen saturation , and should be used carefully as a routine intervention in patients who have pneumonia BACKGROUND Normal saline instillation prior to endotracheal suctioning is a critical care ritual that persists despite a lack of demonstrated benefit . Saline instillation may dislodge viable bacteria from a colonized endotracheal tube into the lower airway , overwhelming the defense mechanism of immunocompromised patients . OBJECTIVE To determine the extent to which normal saline irrigation and suction catheter insertion dislodge viable bacteria from endotracheal tubes . METHODS Endotracheal tubes from 10 critical care patients intubated for at least 48 hours were obtained immediately after extubation . Each tube was used in r and om order for both saline instillation and suction catheter insertion . Dislodged material was cultured for quantitative analysis . RESULTS Suction catheter insertion dislodged up to 60,000 viable bacterial colonies . A 5-mL saline instillation dislodged up to 310,000 viable bacterial colonies . CONCLUSIONS The potential for infection caused by dislodging bacteria into the lower airway is additional evidence that routine use of saline during suctioning procedures should be ab and oned The purpose of this study was to determine whether using a st and ard method of endotracheal suctioning , to ensure consistent use of available knowledge , had any impact on patient care . Using experimental study design , the results of two different methods of suctioning in a cardiovascular surgery intensive care unit were compared . One method was the suctioning procedure applied by the nurses working in the intensive care unit . The other one , st and ard suctioning procedure , was developed based on the related literature and applied to the patients assigned to the experimental group by the research er herself . Mean arterial blood pressure ( MAP ) , heart rate ( HR ) , and arterial blood gases ( ABGs ) were measured before the procedure , immediately after , 5 and 15 minutes after the procedures for both control and experimental group . The majority of the nurses suctioning the control group did not evaluate the ABGs after endotracheal suctioning , none of these patients was given oxygen both before and after the suctioning , and suctioning took longer time than recommended . To compare the results of the two different methods , the values of MAP , HR , PO2 ( arterial oxygenation ) , PCO2 ( arterial carbondioxide ) , and HCO3- ( hydrogen carbonate ) 15 minutes after the procedure were used , and the differences between the two methods were statistically significant ( P < 0.05 )
PURPOSE This study aim ed to systematic ally review studies that investigated the effects of normal saline instillation before endotracheal suctioning and to determine the views of nurses concerning this procedure .
However , normal saline instillation is used frequently by nurses to manage thick and tenacious secretions in clinical practice .