Introduction
Patients admitted to an intensive care unit need to be intubated to keep their airways patent. This procedure is called endotracheal suctioning and implies inserting a tube into the patient’s trachea and connecting it to a ventilator. The suctioning is performed to remove secretions that tend to accumulate in the airway because the presence of the endotracheal tube results in patients’ loss of ability to cough. An impaired mucociliary function can also contribute to the generation of secretions, as well as, the tube itself may be instrumental to the airway irritation (Ayhan et al., 2015).
Such circumstances can lead to potentially life-threatening conditions such as ventilator-associated pneumonia, which may develop in patients as a result of poor suctioning management by medical personnel. Saline installation is a procedure that has been used by nurses for several decades to facilitate the process of removing secretions with the help of the solution. Numerous studies are exploring the topic of using saline instillation during suctioning, and the use of the PICO method as part of the search strategy can help find the most relevant ones.
Main body
During the research phase, four databases have been chosen as the primary resources for conducting the search for articles dedicated to the topic of best practices concerning suctioning and the use of saline. The first and the one which returned the largest number of relevant sources was PubMed, which has more than thirty million citations and helps conduct searching across other resources such as Medline. Another database used in the search was ScienceDirect, which contains articles from more than two thousand scholarly journals, and allows users to easily find evidence and information for their research. Finally, the last database utilized in the search was BioMed Central (BMC), which is part of Springer Nature, this platform offers access to a wide variety of quality peer-reviewed journals.
I used the population, intervention, comparison, and outcome (PICO) method to find research and evidence concerning the best practices of endotracheal suctioning and the use of saline. Before beginning the search, the following PICO question was formulated “In ventilated patients is saline instillation during endotracheal suctioning harmful?” Based on the question, keywords were then identified for each of the PICO elements, which was performed to conduct a successful search (CKN, n.d.). The following keywords were used in the search “saline instillation,” “endotracheal suctioning,” and “ventilated patients.” The search across three databases has yielded a total of twelve articles, and the four most recent were eventually used as sources.
All of the four studies chosen for the research had similar findings and noted adverse effects of saline instillation on the health of patients. Giakoumidakis et al. (2011) studied two different approaches to suctioning involving with and without saline and measured oxygen saturation, as well as the volume of drained secretions. The result showed that saline instillation was associated with a lower level of oxygen saturation, which did not return to the baseline even after fifteen minutes. Similarly, Wang et al. (2017) reviewed five control trials that demonstrated significantly low oxygen saturation in patients following the saline instillation procedure.
These findings are in line with the results of a survey conducted among ninety nurses and ninety therapists who, apart from low oxygen saturation, also reported patient agitation (Leddy & Wilkinson, 2015). Moreover, one study found that saline instillation can displace bacteria down the airway and increase the risk of ventilator-associated pneumonia (Franchi et al., 2015). Thus, according to the evidence of the most recent studies, it can be concluded that saline instillation during endotracheal suctioning has harmful effects on patients and must not be utilized in the modern clinical setting.
PICO is a helpful method in my nursing practice, and I plan to use it more often now since this study has expanded my understanding of how it can be implemented. Currently, I have a problem concerning patients with diabetes and the right approach to their treatment. Generally, people with this disease are told to perform physical activity, but it is unclear which type of exercise is more likely to be more beneficial.
I have developed a question using the PICO method to facilitate my search across different databases. After choosing the best structure for my inquiry, I created the following question “In patients with type 2 diabetes, does resistance exercise compared to aerobic exercise increase quality of life?” Thanks to the PICO approach, I managed to discover relevant sources and relying on the evidence presented there improved my clinical practice.
Conclusion
There is a variety of studies containing evidence about the use of saline instillation during the endotracheal suctioning procedure, and the PICO method can be an effective way to find the most relevant sources. The search for sources in this paper was performed utilizing a PICO question and keywords based on it. All articles used in the research reported low levels of oxygen saturation in patients after saline instillation, which makes this procedure potentially harmful and unacceptable in practice. The PICO method helped me find the necessary information on diabetes and considerably facilitated my search, and positively affected my expertise.
References
Ayhan, H., Tastan, S., Iyigun, E., Akamca, Y., Arikan, E., & Sevim, Z. (2015). Normal saline instillation before endotracheal suctioning: “What does the evidence say? What do the nurses think?”: Multimethod study. Journal of Critical Care, 30(4), 762–767.
CKN. (n.d.). Finding the evidence – Using PICO searching to support evidence-based nursing practice. CKN.
Franchi, A. C., Filho, A. P., Bottura, C., Miranda, C. H., Ferreira, F. B., de C Borges, M., de C Santana, R. & Okino, V. T. (2015). Could saline instillation displace bacteria from the endotracheal tube biofilm to lower airways during suctioning procedure? Critical Care, 19(2), 1–24.
Giakoumidakis, K., Kostaki, Z., Patelarou, E., Baltopoulos, G., & Brokalaki, H. (2011). Oxygen saturation and secretion weight after endotracheal suctioning. British Journal of Nursing, 20(21), 1344–1351.
Leddy, R., & Wilkinson, J. M. (2015). Endotracheal suctioning practices of nurses and respiratory therapists: How well do they align with clinical practice guidelines. Canadian Journal of Respiratory Therapy, 51(3), 60–64.
Wang, C., Tsai, J., Chen, S., Su, C., Chen, L., Lin, C., & Tam, K. (2017). Normal saline instillation before suctioning: A meta-analysis of randomized controlled trials. Australian Critical Care, 30(5), 260–265.