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.
