title: Normal saline instillation before endotracheal suctioning: "What does the evidence say? What do the nurses think?": Multimethod study.
abstract: OBJECTIVE
  This study aimed to systematically review studies that investigated the effects of normal saline instillation before endotracheal suctioning and to determine the views of nurses concerning this procedure.
  
  
  METHODS
  This study was carried out in 2 stages as a systematic review and a descriptive study. In the first stage, the Medline and CINAHL databases were searched. The second stage of the study consisted of a survey of 65 intensive care nurses.
  
  
  RESULTS
  The systematic review identified 7 studies. Nearly all of the studies had a self-controlled clinical trial design. Normal saline instillation before endotracheal suctioning was demonstrated to decrease patient oxygenation in most studies (P < .05). However, the impact of normal saline on hemodynamics and the incidence of ventilator-associated pneumonia remain unclear. Most nurses (87.7%) apply normal saline instillation.
  
  
  CONCLUSIONS
  Although the effects of normal saline instillation on hemodynamics and pneumonia incidence remain controversial, this procedure significantly decreases the oxygenation. Therefore, the use of this procedure is not recommended. However, normal saline instillation is used frequently by nurses to manage thick and tenacious secretions in clinical practice. Additional studies are needed to determine the effectiveness of applications that may be alternatives to normal saline instillation in the management of these secretions.
authors.affiliation: School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey. Electronic address: hayhan@gata.edu.tr.
authors.forename: Hatice
authors.initials: H
authors.lastname: Ayhan
authors.affiliation: School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Sevinc
authors.initials: S
authors.lastname: Tastan
authors.affiliation: School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Iyigun
authors.affiliation: Erzurum Maresal Cakmak Miltary Hospital, Erzurum, Turkey.
authors.forename: Yagmur
authors.initials: Y
authors.lastname: Akamca
authors.affiliation: Haydarpasa Training Hospital,Gulhane Military Medical Academy, Istanbul, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Arikan
authors.affiliation: Haydarpasa Training Hospital,Gulhane Military Medical Academy, Istanbul, Turkey.
authors.forename: Zubeyde
authors.initials: Z
authors.lastname: Sevim
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001291:Attitude of Health Personnel; D064648:Critical Care Nursing; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods / Q000451:nursing*; D053717:Pneumonia, Ventilator-Associated / Q000451:nursing / Q000517:prevention & control; D012965:Sodium Chloride / Q000008:administration & dosage*; D013396:Suction / Q000379:methods / Q000451:nursing*; D011795:Surveys and Questionnaires; D014132:Trachea; D055815:Young Adult
chemical_list: D012965:Sodium Chloride
keywords: Endotracheal suctioning; Intensive care nurse; Normal saline instillation