HINT: Can normal saline be used to help with suctioning?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
HINT: Can normal saline be used to help with suctioning?
SITUATION:
This Quick Hit was informed by a Connected Care Live consult from a home and community care provider asking for clarification about the use of normal saline when suctioning via tracheostomy tube.
BACKGROUND:
Children with tracheostomy tubes require suctioning to help clear their airway of secretions. They are at risk of thickened secretions because the tracheostomy tube bypasses their upper airway thus impacting the normal heat, humidification and filtration mechanisms of the respiratory tract. Historically, normal saline was used in hospital settings as it was thought to help loosen and mobilize thick secretions. Current best practice guidelines suggest that this is not a safe and effective practice.
ASSESSMENT:
Instilling normal saline for tracheostomy tube suctioning is not recommended for the following reasons:
It may increase the risk for infection as bacteria in the tracheostomy tube can be washed down to the lower respiratory tract.
It may impact oxygenation as you are introducing liquid to the respiratory tract
Normal saline does not mix with mucous and therefore does not make secretions thinner
RECOMMENDATION:
Connected Care recommends the following when suctioning children with tracheostomy tubes:
Do not instill normal saline when suctioning a tracheostomy tube
Review different ways to prevent thickened secretions including systemic hydration and airway humidification.
Consider pulmonary clearance techniques to mobilize secretions. Discuss options with the child’s family caregivers and primary care team.
Review the following AboutKidsHealth article that outlines the different types and methods of tracheostomy tube suctioning.
