Wednesday, March 04, 2015

Clinical Inquiry Series

The RNs at St. Joseph Hospital are curious and inquisitive when it comes to best nursing practice.  Our nurses are encouraged to submit their clinical practice questions to our Research Department for review of the best evidence to guide patient care.  Here is the first of our series entitled "Clinical Inquiry".

Question:  Why does St. Joseph RTs and RNs still lavage ET tubes with normal saline when evidence-based practice research shows this is not helpful and potentially harmful?

Answer: According to Lippincott’s Nursing Procedures, the use of normal saline is not included in the guidelines for suctioning. Current research is not clear.  A recent study indicates that not using normal saline before endotracheal suction decreases the incidence of ventilator-associated pneumonia and associated medical costs (Mei-Yu, Shu-Hua,  & Yi-Hui, 2012). This is contradicted by findings from another recent study which found that instillation of normal saline decreased incidence of pneumonia in intubated and ventilated patients (Caruso, Denari, Ruiz, Demarzo, & Deheinzelin, 2009).  One possible explanation for the discrepancy in results is from variations in the administration of the normal saline, time to suctioning, patient position, and dosages of saline. 

Response written by Kathleen Pentecost, SRN CBU, BA Sociology & Carla I. Morales, SRN CBU, BS Psychobiology

Caruso,P. Denari,s., Ruiz, S. A. L., Demarzo, S. E., Deheinzelin, D. (2009). Instillation of normal saline before suctioning reduces the incidence of pneumonia in intubated and ventilated adults.  Critical Care Medicine, 37, 32-38.
Lippincott Williams & Wilkins. (2009). Lippincott's nursing procedures. Philadelphia: Lippincott
Williams & Wilkins.
Mei-Yu, L., Shu-Hua, C., & Yi-Hui, S. (2012). Reducing Ventilator-Associated Pneumonia (VAP) by not using instillation saline before suctioning [Chinese]. Journal of Nursing & Healthcare Research, 8(4), 325-331.