2002 OPEN FORUM Abstracts
INCIDENCE OF NORMAL SALINE LAVAGE BY RTS IN A LARGE ACUTE CARE HOSPITAL
W French, MA, RRT, K Bauer, BS, RRT, Lakeland Community College, Kirtland, OH
Introduction
Direct
observation suggests that the instillation of a normal saline (NSI) bolus prior
to endotracheal suctioning is common practice in most intensive care units.
This practice persists despite the fact that there is very little objective
data supporting its use or documenting its efficacy. Further, several recent
studies have documented potential harmful effects associated with NSI. Therefore,
because even the most supportive studies have been, at best, ambivilent, clearly
the use of NSI should be limited if not completely eliminated from clinical
practice. However, before educators and clinical administrators can discourage
NSI, they need to understand how much it is used and why it used by practitioners.
This knowledge is best gained through surveying the practitioners themselves.
Methods
A
survey consisting of 8 questions was distributed to 76 respiratory therapists
(RTs) employed by a large acute care hospital. A total of 33 surveys were returned.
The first four questions provided background data about the practitioner respondents,
while the last four questions asked the practitioners how often he/she does
NSI, how much NS is typically instilled, why it is done, and where it was learned.
In addition, for comparison purposes, a similar survey was administered to the
nursing staff in the intensive care units. However, those results are not presented
here.
Results
Ninety-three percent of the respondents
were RRTs. Sixty-three percent reported their highest education level being
an AD, while 27% had a BS or higher. Experience ranged from 12% with less than
two years to 24% having more than fifteen years. Sixty-seven percent reported
that they perform NSI occasionally while 24% reported performing NSI routinely
and 12% performed it rarely. Eighty percent reported instilling three mL or
less, while 13% instilled 3–4 mL. Fifty-eight percent reported that their
principal reason for NSI was to ?liquify the mucus.’ Forty-five percent
listed ?lubricate mucus? as their principal reason for NSI. Six percent listed
?stimulate cough? as their principal reason. Sixty percent reported learning
NSI in school. The remaining responses were farily evenly distributed among
established policies, published literature and watching other practitioners.
There were no correlations between NSI practice and either education or experience.
Discussion
Clearly,
in this particular facility NSI is common practice, based on the survey results.
Furthermore, it is a practice that cuts across boundaries set by education and
experience. It is also clear that the RTs who responded have a poor understanding
of NSI, as the only study to document any positive benefit concluded that the
principal mechanism of NSI was cough stimulation. Finally, educators might take
note of the fact that the majority of respondents reported learning NSI in school.
Obviously, this study is very limited in that it only looked at a group of RTs
in one facility. However, based on observation and discussion with others, the
authors believe that these results are typical of the RT workforce at large.
OF-02-058