1. Palatnik, AnneMarie MSN, RN, APN-BC

Article Content

Did you know that Nursing2011 Critical Care has its own website? The address,, is at the bottom of every journal page. Subscribers can access all the website content, and nonsubscribers can access selected popular articles. Everyone can participate in our new Quick Polls, which pose a question (sometimes one with a bit of controversy) and invite reader participation. You can see the results on the main page by clicking on the Results link under the question. I'll occasionally address a Quick Poll question in my editorial.

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Our first poll asked, "Do you instill normal saline before endotracheal (ET) tube suctioning?" Of the nurses who participated, 75% responded "no," and 25% responded "yes."


This practice has been debated for years. Traditionally, the thought had been that normal saline instillation would thin and loosen tenacious secretions and ultimately enhance their removal by stimulating the cough reflex. For years, this was my practice because that was the way that I was taught and that was the way we'd always done it. I never once questioned the value of the practice. As I matured in my career, so did evidence-based practice. And as a profession we started and continue to challenge some of our practices that were based on tradition instead of the evidence.


So just what does the evidence say about instilling normal saline before ET suctioning? The updated American Association for Respiratory Care (AARC) clinical practice guidelines, Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010, recommend that normal saline instillation shouldn't be routinely performed before ET suctioning. Most of the references used to update this guideline indicate that instilling saline before suctioning isn't likely to help, and in fact may be harmful to patients, decreasing oxygenation and increasing their risk for pneumonia.


Remember to visit our website and participate in the Quick Polls. Until the next time, be healthy, be happy, be great advocates for your patients, and challenge "sacred cow" practices that lack supporting evidence.


AnneMarie Palatnik, MSN, RN, APN-BC

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Director of Clinical Learning Center for Learning Virtua Health Mount Laurel, N.J.




American Association for Respiratory Care. Clinical practice guidelines: Endotracheal suctioning of mechanically ventilated patients. Respir Care. 2010;55(6):758-764.


Rauen CA, Chulay M, Bridges E, Vollman RM, Arbour R. Seven evidence-based practice habits: Putting some sacred cows out to pasture. Crit Care Nurse. 2008;28(2):98-123.