Normal saline instillation before suctioning for adult patients with altered airways: reviewing the evidence

Normal saline instillation into tracheostomy or endotracheal tubes, collectively known as altered airways, is often indicated when airway secretions become difficult to manage. Internationally, a clear gap exists between scientific evidence and the practice of normal saline instillation before suctioning the altered airway.

The objective of this review is to appraise and synthesise the evidence as to whether normal saline instillation before suctioning causes adverse effects on adult patients with altered airways.

A mixed-method review was undertaken to appraise hierarchical quantitative-designed studies available in literature, and critical appraisal skill programme tools were used to judge trustworthiness of studies. A systematic search disclosed 828 potentially eligible studies, of which 6 hierarchical relevant studies were chosen for appraisal.

Collaboratively, findings established that normal saline instillation before suctioning caused adverse effects on adult patients with altered airway.

The evidence synthesis does not support the practice of normal saline instillation into the adult altered airway before suctioning for management of airway secretions.