Hazards of Saline Instillation

Normal saline has been used during endotracheal and tracheostomy suctioning to assist in the removal of tenacious secretions.   

Normal saline and mucus do not mix. Therefore, normal saline does not thin or mobilize secretions. 

Normal saline has been associated with decreased oxygenation, worsening desaturation over time, and increased heart rate 4-5 minutes after suctioning. 

Patients also reported increased anxiety, dread, and pain with the instillation of saline.

Up to 5 times the bacterial colonies were dislodged when saline was instilled which may contribute to lower airway contamination.

The best interventions for managing thick tenacious secretions and preventing mucus plugs are:

Hydration

Adequate humidification

Use of mucolytic agents- Mucomyst

Effective cough