Develop a PICO question for the instillation of saline during endotracheal suctioning.
Consider/Describe how you could apply PICO to problems in your workplace in order to influence things in
clinical practice. Develop a PICO to represent your work setting.
Submit your search strategies, search results, and PICO question and application to clinical practice as an
WEEK 4: PICO QUESTION
As part of my outline to use to search for evidence related to the best practices for
suctioning and whether the instillation of saline while suctioning is an acceptable
technique, I will utilize the University of Phoenix library, where I know the research I
search for is accurate and up to date information. I will also use Google Scholar as part of
my search engine.
According to the American Association for Respiratory Care (AARC) article
Endotracheal Suctioning of Mechanically Ventilated Patients With Artificial Airways
2010,“In preparation for suctioning event, delivery of 100% oxygen in pediatric and
adult patients and 10% increase of baseline in neonates for 30-60 seconds prior to the
suctioning event is suggested, especially in patients who are hypoxemic before
suctioning. A patient should be placed on a pulse oximeter to access oxygenation during
and following the procedure. There are 2 methods of endotracheal suctioning base on the
selection of catheter: open and closed. The open suctioning technique requires
disconnecting the patient from the ventilator, while the closed suctioning technique
involves attachment of a sterile, closed, in-line suction catheter to the ventilator circuit,
which allows passage of a suction catheter through the artificial airway without
disconnecting the patient from the ventilator. The duration of each suctioning event
should be no more than 15 seconds.” As for the instillation of saline while suctioning,
according to the same article listed as above, “instillation refers to the administration of
aliquots of saline directly into the trachea via an artificial airway. It is hypothesized that
normal saline instillation may loosen secretions, increase the amount of secretions
removed, and aid in the removal of tenacious secretions. However, there is insufficient
evidence to support this hypothesis. Normal saline instillation appears to enhance
secretion clearance through cough stimulation in adults, and a recent report suggests that
normal saline instillation prior to suctioning is associated with decreased incidence of
ventilator-associated pneumonia in ventilated adult patients. The great majority of the
references used to update this guideline indicate that normal saline instillation is unlikely
to be beneficial, and may in fact be harmful. Therefore, it should not be routinely
performed prior to performing endotracheal suctioning.”
PICO question: Duringendotracheal or tracheostomy tube suctioning, the instillation of
normal saline into the endotracheal or tracheostomy tube prior to suctioning, does it help
loosening or thin secretions or cause more harm to the patient?
Patient:Patient requires suctioning of endotracheal tube
Intervention: Discontinue the use of normal saline
Comparison: Will normal saline help loosening and thin the secretions or will it
further harm the patient?
Consider/Describe how you could apply PICO to problems in your workplace in order to influence things in
clinical practice. Develop a PICO to represent your work setting.
Submit your search strategies, search results, and PICO question and application to clinical practice as an
WEEK 4: PICO QUESTION
As part of my outline to use to search for evidence related to the best practices for
suctioning and whether the instillation of saline while suctioning is an acceptable
technique, I will utilize the University of Phoenix library, where I know the research I
search for is accurate and up to date information. I will also use Google Scholar as part of
my search engine.
According to the American Association for Respiratory Care (AARC) article
Endotracheal Suctioning of Mechanically Ventilated Patients With Artificial Airways
2010,“In preparation for suctioning event, delivery of 100% oxygen in pediatric and
adult patients and 10% increase of baseline in neonates for 30-60 seconds prior to the
suctioning event is suggested, especially in patients who are hypoxemic before
suctioning. A patient should be placed on a pulse oximeter to access oxygenation during
and following the procedure. There are 2 methods of endotracheal suctioning base on the
selection of catheter: open and closed. The open suctioning technique requires
disconnecting the patient from the ventilator, while the closed suctioning technique
involves attachment of a sterile, closed, in-line suction catheter to the ventilator circuit,
which allows passage of a suction catheter through the artificial airway without
disconnecting the patient from the ventilator. The duration of each suctioning event
should be no more than 15 seconds.” As for the instillation of saline while suctioning,
according to the same article listed as above, “instillation refers to the administration of
aliquots of saline directly into the trachea via an artificial airway. It is hypothesized that
normal saline instillation may loosen secretions, increase the amount of secretions
removed, and aid in the removal of tenacious secretions. However, there is insufficient
evidence to support this hypothesis. Normal saline instillation appears to enhance
secretion clearance through cough stimulation in adults, and a recent report suggests that
normal saline instillation prior to suctioning is associated with decreased incidence of
ventilator-associated pneumonia in ventilated adult patients. The great majority of the
references used to update this guideline indicate that normal saline instillation is unlikely
to be beneficial, and may in fact be harmful. Therefore, it should not be routinely
performed prior to performing endotracheal suctioning.”
PICO question: Duringendotracheal or tracheostomy tube suctioning, the instillation of
normal saline into the endotracheal or tracheostomy tube prior to suctioning, does it help
loosening or thin secretions or cause more harm to the patient?
Patient:Patient requires suctioning of endotracheal tube
Intervention: Discontinue the use of normal saline
Comparison: Will normal saline help loosening and thin the secretions or will it
further harm the patient?
