The Science Journal of the American Association for Respiratory Care

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.

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