title: Consensus among physiotherapists in the united kingdom on the use of normal saline instillation prior to endotracheal suction: a Delphi study.
abstract: OBJECTIVE
  To investigate whether physiotherapists consider normal saline instillation (NSI) useful before endotracheal suctioning and, if so, when.
  
  
  METHODS
  Sixty-eight respiratory physiotherapists recruited from the United Kingdom's Association of Chartered Physiotherapists in Respiratory Care agreed to participate in a Delphi study. Clinicians' opinion of when NSI should be used was established and developed into statements. Level of agreement with each statement was collated through three rounds of a questionnaire. Clinicians' experiences were also reported.
  
  
  RESULTS
  From the 52 responses to the third questionnaire, there was consensus that respiratory physiotherapists in the United Kingdom would use NSI when sputum retention is a problem, particularly when treatment options are limited (96%) and when sputum is obstructing the airway (92%). They agreed that non-bronchoscopic bronchoalveolar lavage can be used to resolve persistent atelectasis (70%). They would not use NSI for a test treatment during initial assessment without evidence of retained secretions (94%), when secretions are copious but can be cleared by alternative physiotherapy techniques (96%), to enhance a cough unless very strong evidence indicates retained secretions (81%), or to compensate for inadequate suction technique (90%).
  
  
  CONCLUSIONS
  This study provides clinicians' views about when NSI could be used.
authors.affiliation: School of Health Science, Faculty of Health and Social Care, The Robert Gordon University, Aberdeen, Scotland. f.e.roberts@rgu.ac.uk
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Roberts