NORMAL SALINE IRRIGATION

Normal Saline Irrigation of Artificial Airways Prior To Suctioning

Abstract

Normal saline has been broadly used during endotracheal and tracheal suctioning. This study explains the facts about normal saline irrigation of artificial airways prior to suctioning.

Table of Contents

CHAPTER 1: INTRODUCTION4

CHAPTER 2: LITERATURE REVIEW6

CHAPTER 3: RESEARCH METHODOLOGY27

CHAPTER 4: RESULTS43

CHAPTER 5: DISCUSSION52

CHAPTER 6: CONCLUSION57

REFERENCES60

ANNOTATED BIBLIOGRAPHY75

Chapter 1: Introduction

Normal saline (NS) has been widely utilized during endotracheal and tracheal suctioning. Clinicians have used NS believing it breaks up pulmonary secretions and helps with their removal during suctioning, especially in the presence of thick secretions. Insertion of an artificial airway (Day et al. 2001; Celik & Elbas 2000; Donald et al. 2000), either endotracheal, nasotracheal or tracheostomy, inhibits normal mucociliary clearance, thus increasing the risk of secretion retention and pneumonia. Suctioning is one of the most common procedures in the intensive care unit and high dependency wards; its aim is to remove respiratory tract secretions, thus maintaining airway patency, and prevent complications of secretion retention such as ventilator-associated pneumonia (VAP).

Normal saline instillation is defined as delivery of 2 to 10 cc of normal saline solution (0.9%) into an artificial airway prior to suctioning for either tracheal toilet or as a component of a physiotherapy intervention. It can be included during both open and closed suction methods. This technique is utilized by many health practitioners and is believed to increase sputum yield by diluting and loosening secretions, stimulating a cough and lubricating the suction catheter. However, there are conflicting views about the safety (effect on haemodynamic, respiratory and intracranial systems) and efficacy (improved oxygenation, increased secretion yield, tube patency, prevention of VAP) of this procedure. Narrative reviews claim that it results in hypoxaemia, bronchospasm, increased intracranial pressure, cardiac arrest, respiratory arrest, infection, patient anxiety, patient fear and pain with no improvement in oxygenation or sputum yield.

Purpose of the Study

The purpose of this study is to examine the effects of normal saline instillation on haemodynamic parameters, oxygenation, dyspnoea, patient discomfort, intracranial parameters, sputum yield, airway patency, respiratory mechanics and VAP in patients with an artificial airway compared with suction alone.

Research Question

Q. How normal saline irrigation of artificial airways prior to suctioning can be identified through different phases of research?

Chapter 2: Literature Review

Suctioning is described as the mechanical aspiration of pulmonary secretions from a patient with an artificial airway in position (AARC 1993). In a healthy patient, the action of ciliated cells in the airways, the local immune system, and the cough reflex are essential for the destruction and removal of micro-organisms as well as clearing debris from the lungs (Ashurst 1992). However, in the critically or acutely ill patient, these functions may be severely compromised, resulting in an excessive production of secretions, which may prove difficult to expectorate.

Endotracheal and tracheostomy tubes form artificial airways, which bypass the normal physiological processes and inhibit the cough reflex. This leaves the respiratory tract vulnerable to opportunistic infections, with an increased production of mucus and reduced secretion of pneumocytes and surfactant. An inability to expectorate this mucus, which is often thick and ...