Academic Master

Human Resource And Management

What is your opinion on the use of saline during suctioning? Are there any instances when the use of saline during suctioning is acceptable? 

While normal saline is widely used by respiratory therapists and nurses, this action is not recommended for use during suctioning of the endotracheal tubes in neonates. Historically, suctioning the endotracheal tube has been extensively used to remove pulmonary secretions that can potentially block the endotracheal tube (Morrow, & Argent, 2015). Such blockage could impair air exchange in patients of all ages who are placed on tubes.

According to patients who have undergone endotracheal suctioning, this experience is very painful and profoundly unpleasant. One of these patients reported that the experience was rated a 10 out of 10 on the pain rating scale. They described this experience of having saline instillation as one where they felt “like they were drowning.” The suction catheter would then be shoved into the patient until the tube made the patient cough against the endotracheal tube. This experience, according to the patient, was very excruciating. Furthermore, every bit of breath remaining in the patient is then sucked out (“Saline Instillation: Helpful or Harmful?” 2018). Why take a patient through all this pain and struggle?

This being a very painful and distressing intervention, it should be performed with discretion and thought. It is important to first look out for the indications of suctioning and ensure that you explain to the patient all the expected outcomes of the procedure. Once the patient is informed of the intervention’s risks and/or negative effects, they can be left at the discretion to decide whether they want to undergo the same(Molnar, 2018).

In some situations, using saline during suctioning is acceptable, especially when it is used well. In this case, the saline is used to loosen and moisturize dried secretions and thin out tenacious or thick secretions within the ET tube to mobilize and assist in the removal of the same. Practitioners usually instill a tiny amount (about 0.2 to 5 mL) of sterile normal saline before inserting the suction catheter (“Saline Instillation: Helpful or Harmful?” 2018). However, there is still the question of whether there is enough evidence to prove that saline instillation is an efficient process and if it should be incorporated when suctioning the endotracheal tube of the neonate.

A national survey of the pediatric intensive care unit performed in 1996 showed that virtually all of these nurses use the saline irrigant during suctioning. This study of the ET tube suctioning procedures in adult critical care units revealed that approximately 75 percent of suctioning policies always incorporate using normal saline in cases of thick secretions. Another survey in a large university hospital showed that about 71 percent of respiratory therapists usually instilled saline before suctioning (Molnar, 2018). Conversely, a majority of nurses seldom used it. From this data, it is evident that no standardized practice has been incorporated for saline instillation.

Scientific evidence shows that saline instillation might not have a positive effect because it does not improve pulmonary function. It is also proven that it is not efficient in thinning secretions or facilitating their removal. It is sad that the practice persists despite the numerous risks associated with it. My opinion about using saline during suction is that it should not be used because there is no research-based evidence for it.


Molnar, H. (2018). How a tracheostomy is Retrieved 26 February 2018, from

Saline Instillation: Helpful or Harmful?. (2018). Retrieved 26 February 2018, from

Morrow, B. M., & Argent, A. C. (2015). Respiratory Physiotherapy and Endotracheal Suctioning During Mechanical Ventilation. In Pediatric and Neonatal Mechanical Ventilation (pp. 687-710). Springer, Berlin, Heidelberg.



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