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There is evidence against instilling saline into tracheostomies before suctioning. 1 If readers go to and search for "suctioning and saline," they will find many articles on the topic. Most of these examine the added physiologic distress that it imposes on patients 2-4 (including children 5), but others demonstrate that the saline is actually washing microorganisms from the inside of the trach into the lungs, 6, 7 putting the patient at greater risk for pneumonia. There is no evidence that the saline actually loosens secretions-the thickest secretions are unaffected by a quick wash of saline, and the saline doesn't reach most of these secretions. Blackwood concludes, "It is proposed that after 25 years of inconsistent practice in trying to remove thick and tenacious secretions, it is time to focus on ways to prevent thick and tenacious secretions." 8




1. Day T, et al. Suctioning: a review of current research recommendations. Intensive Crit Care Nurs 2002;18(2):79-89. [Context Link]


2. Ackerman MH. The effect of saline lavage prior to suctioning. Am J Crit Care 1993;2(4):326-30. [Context Link]


3. Kinloch D. Instillation of normal saline during endotracheal suctioning: effects on mixed venous oxygen saturation. Am J Crit Care 1999; 8(4):231-40. [Context Link]


4. O'Neal PV, et al. Level of dyspnoea experienced in mechanically ventilated adults with and without saline instillation prior to endotracheal suctioning. Intensive Crit Care Nurs 2001;17(6):356-63. [Context Link]


5. Ridling DA, et al. Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children. Am J Crit Care 2003;12(3):212-9. [Context Link]


6. Freytag CC, et al. Prolonged application of closed in-line suction catheters increases microbial colonization of the lower respiratory tract and bacterial growth on catheter surface. Infection 2003; 31(1):31-7. [Context Link]


7. Hagler DA, Traver GA. Endotracheal saline and suction catheters: sources of lower airway contamination. Am J Crit Care 1994;3(6):444-7. [Context Link]


8. Blackwood B. Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm). J Adv Nurs 1999;29(4):928-34. [Context Link]