Saline in Endotracheal Suctioning: Does It Help?


Patients with severe breathing problems require frequent suctioning, especially after surgeries. The procedure is carried out by nurses. One of the common yet discouraged practices is the installation of saline during suctioning. The nurse that used saline, in this case, believed that it is the only way of losing the patient’s secretions. Ascertaining the effect of the installation of saline during endotracheal suctioning is essential in preventing the risk to patients and educating nurses on the acceptability of this practice.

Search Strategies for Best Practices

The search for the best practices was conducted through the use of online databases. The major rule that was applied to all strategies was the relevance of all sources. Therefore, the search tool looked for articles published within the last five years. The key phrases used in the search were: “best practice”, “suctioning”, “installation of saline”, and “acceptable”. To ensure the relevance of the articles to the query, the search engine was customized to seek out literature, including these terms. Also, in all cases, the search tool was tasked to look for similarities on only in the title, but also within the texts themselves.

The first database was Google Scholar. In response to the aforementioned query, it returned 364 articles with corresponding words either in the title or in content. The articles were sorted out based on two factors: the relevance to this project’s context and the number of citations. The second database was PubMed. Only thirty articles were selected by the search engine. As there is no visible indication of how much a particular piece has been cited on PubMed, the relevant articles were selected based on relevance to this project. The third database was Cochrane Library. The search returned ten articles, but none of them was taken since there were no scoping reviews that would cover the issue of saline instillation during suctioning.

Summary of Evidence

It should be noted that the appropriateness of saline intervention has already been discussed and considered outdated. Partially, the reason lies in this sphere being untested. This is the reasoning that was adopted by the authors of an integrative review aiming to synthesize evidence regarding the safety of instilling saline during endotracheal suction (Schults et al., 2018). This study is noteworthy because it collects the already existing research findings and makes conclusions based on them. The results showed that saline distillation during endotracheal suctioning had “a transient, negative effect on oxygenation in the short term, however, this was not persistent” (p. 4). Therefore, the decrease in oxygen saturation makes provides evidence that this practice harms the patients.

Another systematic review has also suggested that applying saline during suctioning should be avoided. The authors of this research focused on the procedures themselves rather than the influence of saline on oxygen. Pinto et al. (2020) studied how nurses approached endotracheal suctioning with saline since it was a widely used practice. The findings demonstrated that “saline installation during suctioning does not have any effect on improving patient’s outcome” (p. 31). Moreover, patient safety was further jeopardized by the nurses’ lack of adherence to safety standards, like handwashing and keeping the catheter sterile. Combined with the lack of any meaningful effect on patients, installation of saline during suctioning is evidenced to unjustifiably increase the risk to patients’ health.

PICO Question

The ambiguity of using saline while suctioning propels developing a PICO question. The population incorporates adult patients requiring suctioning to breathe. The intervention is the installation of saline during the procedure of endotracheal suctioning. The comparison would be not used before, during, or after the procedure. The outcome is the safety of the patient and health improvement resulting from the procedure. The overall PICO question is: in adult patients, requiring suctioning to breathe, would use saline during endotracheal suctioning, when compared to not using saline, be safe and help patients recover faster?

PICO Application to Workplace

As displayed in the aforementioned article, using saline while suctioning is not safe and may be harmful. Kadhim and Mhabes (2020) argue that proper installation of saline before suctioning does not yield any significant improvements. They also suggest that the reason why nurses continue to instill saline lies in the “lack of nurses’ knowledge about recent evidence-based recommended practice guidelines” (p. 7169). Moreover, once the nurses were educated in the new guidelines, they stopped doing this procedure.

Applying the accumulated knowledge to this project’s context requires developing a PICO question relevant to this workplace. However, in this case, the problem is not the procedure itself, but rather the nurse who still practices it. It appears that the nurse instilled saline because she believed her experience was superior to the guidelines. Therefore, the pertaining PICO question is: would educating nurses on the guidelines cause them to stop using saline while suctioning?


Altogether, it is evident that the nurse overrated her critical care experiences and compromised the patient’s health. There is no evidence suggesting that the installation of saline during endotracheal suctioning helps a patient. However, there is evidence of nurses ignoring safety rules when performing this procedure. The reason for nurses’ continued use of saline lies in their unfamiliarity with the latest guidelines. Educating nurses on the new guidelines will influence them to stop instilling saline during suctioning, thus endangering the patient.


Kadhim, J. J., & Mhabes, F. G. (2020). Effectiveness of an educational program on critical care nurses’ practices regarding endotracheal suctioning of adult patients who are mechanically ventilated in hospitals at AL-Najaf, Iraq. Indian Journal of Forensic Medicine & Toxicology, 14(4), 7163-7171.

Pinto, H. J., D’silva, F., & Sanil, T. S. (2020). Knowledge and Practices of Endotracheal Suctioning amongst Nursing Professionals: A Systematic Review. Indian Journal of Critical Care Medicine, 24(1), 23-32. Web.

Schults, J., Mitchell, M. L., Cooke, M., & Schibler, A. (2018). Efficacy and safety of normal saline instillation and paediatric endotracheal suction: An integrative review. Australian Critical Care, 31(1), 3-9. Web.

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