Term Paper on "Usage of Normal Saline During Suctioning Adults and Ventilator Associated Pneumonia"

Term Paper 5 pages (1900 words) Sources: 3 Style: APA

[EXCERPT] . . . .

Normal Saline during suctioning adults and Ventilator Associated pneumonia

Normal Saline

Tracheal suction is the procedure by which secretions of nay kind are removed from the airway of the patient with the help of a catheter that would be inserted through his nose or his mouth. (Williams, 2006b) in the medical field, most experts are divided upon the issue of whether or not to use normal saline during suctioning, and most especially when the patient is an infant or a very weak and compromised adult. However, this question does not deter nurses and other medical practitioners from using the normal saline technique for suctioning, and the practice is still widely used. Take for example the suctioning of the endotracheal tube. This is how it is carried out: a medical practitioner routinely installs a small amount of what is known as 'sterile normal saline' in order to try to thin out the thick and at times tenacious secretions that may be found within the endotracheal tube. The secretions may at times have dried out and these must be mobilized so that they may be removed through the method of suctioning. (Medscape, 2007)

However, the issue is whether this procedure actually helps the patient, or is it unnecessary? Through time, the procedure of suctioning has been utilized for the purpose of removing any type of obstructions or pulmonary secretions within the endotracheal tube, because such obstructions can block the tube and endanger the patient's life by blocking the air passages, when he is intubated, no matter what his age. Almost all the patients who have had to experience, first hand, endotracheal tube suctioning have reported that it was the most unpleasant sensation, and that it was even extremely painful in some cases. One adult said it was the "worst possible" experience of his life and that it was very painful indeed. The saline instillation made the patient felt hat she was "drowning," and when the suction catheter would be pushed in, it became even worse, she reported, until when the suction was used, she would feel that every last breath had been sucked out of her in an excruciatingly painful experience. This patient's testimonial shows that the entire experience of using suctioning for adults needs much thinking and that one's discretion must be used before attempting such a procedure. These are some of the questions one must think through, feel experts, before the procedure can be started. One, are there any real indications for performing this operation of suctioning on the patient? What exactly is the outcome of performing suctioning? What are all the negative and positive effects of the suctioning procedure? (Medscape, 2007)

It must be noted that it would be an excellent idea for a nurse or a medical practitioner to keep up-to-date on all the latest practices and procedures in their relative fields, so that the patient may get the ultimate benefit out of these 'best practices'. This way, not only would the health care being provided be the best possible, but the methods in which they are provided would also be the best available at any particular time. After all, a nurse or medical practitioner must learn to put his patient first, at any given time. ((Williams, 2006a)

Survey was conducted a few years previously, on a number of nurses and medical practitioners who were working in adult ICU's in a large teaching hospital facility, in order to make an accurate and clear assessment of the advantages and the disadvantages of using normal saline during the endotracheal suctioning of an adult. It was found that while about fifty one percent of those surveyed reported that they rarely used normal saline for the suctioning procedure, about thirty three percent had routinely used saline for the same purpose. While fifty five percent of the nurses used saline to remove and retrieve secretions that would perhaps block the airway, about forty five percent used the same procedure to stimulate a cough in the patient. There was a lack of understanding of the usage of saline for suctioning among the nurses: while sixty four percent reported rarely using saline before suctioning, respiratory therapists reported using normal saline for suctioning. Respiratory therapists seemed to exhibit more awareness than nurses about the benefits or disadvantages of using normal saline for suctioning purposes and to induce a cough in the patient. Evidence was able to prove that when nurses used saline for suctioning, there were more adverse effects in the patient than when a respiratory therapist used it, among them being that of greater oxygen desaturation, and other, a greater risk of cardio pulmonary infections. (Schwenker; Gift, 1998)

However, it must be remembered that the method of suctioning an artificial airway is a very common procedure, routinely followed by nurses and medical practitioners, especially in those patients who are under critical care. This means that patient perspicacity and acuity in this area has been steadily increasing, and this means that suctioning has become common in medical-surgical areas too. The main purpose of suctioning using normal saline is to clear the patient's airway of obstructions and secretions, as mentioned earlier and also to optimize oxygenation and ventilation for the patient. When an artificial airway is used, then it could mean that the patient natural ability to clear out and mobilize his secretion would be compromised to a great extent. One must remember that the main purpose of the airway in the human body is to warm and then to moisten the air that passes through it. (Druding, 1997)

When the functioning is taken over by an artificially created airway, it can become dangerous for the patient. The reason is that when there is an artificial airway, he must rely completely upon the closed ventilator circuit to obtain the proper humidity and moisture levels within the airway. If it so happens that there is a lack of sufficient moisture within the airway, the body would then resort to absorbing water from the airway, and this can only be obtained from the mucous present within. This would mean that then the mucous would become drier than before, because of a lack of moisture, and this would make it more tenacious and difficult to remove than before. This is the reason why nurses prefer to instill normal saline solution into the airway just before the suctioning procedure is started, as they hope that this would help to loosen the secretions, if any within the endotracheal tube, lubricate the suction catheter being inserted, and also make it an infinitely easier task to clear out the secretions form the airway. (Druding, 1997)

Suctioning is in fact a common enough procedure, but it is a procedure that one would not refer to as being 'benign' or in other words, a gentle procedure that will not harm or hurt the patient in any way. The reason is that it can be extremely painful for the patient, and he or she may feel that he is drowning, or that she is being sucked out of all the air from within the body. Suctioning of the endotracheal tube has been associated with various life threatening and serious conditions, like for example hypoxemia and cardiac dysrhythmia. Some experts state that suctioning could also cause cardiac arrest and respiratory arrest, and in certain extreme cases, hypertension, increased intracranial pressure and the condition of atelectasis. Bronchospasm enhanced bronchial mucous production, ventilator assisted pneumonia, pulmonary hemorrhage and affecting tracheo-bronchial mucosa could also emerge because of the suctioning procedure. Researchers and experts also feel that increasingly acute levels of patient anxiety and fear, nosocomial infection, and eventually, death could also become the end result of using the suctioning procedure on a patient's endotracheal tube, without proper research and prior knowledge on the issue. This means that certain standards have to be established with immediate effect, so that all the ill effects and disadvantages of using a procedure whose impact one is not aware of could be avoided. (Druding, 1997)

One of the most common ill effects of using the suctioning procedure with the help of normal saline solution is the onset of 'ventilator assisted pneumonia'. This is the term used to describe the infection of the lung that can occur in a person who has been ventilated in an artificial manner, using 'mechanical ventilation', a breathing machine that breathes artificially for the patient when he is not able to do it himself. It must be noted that when ventilator assisted pneumonia occurs in an individual who has been artificially ventilated by means of the machine, then it can become life threatening, and in some cases, even prove to be fatal for the patient. This is because of the simple fact that since the patient is already seriously ill, and needing to be artificially ventilated by a machine that breathes for him, when an infection of any kind occurs in him, it become much too serious and life threatening. According to JAMA, or the Journal of American Medical Association,… READ MORE

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