Normal Saline Instillation Research Articles

Airway Management and Ventilator-Associated Events.

Airway management techniques are aimed at reducing complications associated with artificial airways and mechanical ventilation, such as retained secretions. The impact of airway management techniques on ventilator-associated events (VAEs) varies considerably by modality. Closed-suction techniques are generally recommended but have limited, if any, impact on VAEs. Normal saline instillation during suctioning is not recommended. Devices designed specifically to remove biofilm from the inside of endotracheal tubes appear to be safe, but their role in VAE prevention is uncertain. Subglottic secretion clearance by artificial cough maneuvers is promising, but more research is needed to assess its clinical feasibility. Continuous cuff-pressure management appears to be effective in reducing microaspiration of subglottic secretions.

Efficacy of Intraperitoneal Instillation of Bupivacaine after Bariatric Surgery: Randomized Controlled Trial.

Obesity is one of the greatest health problems. Bariatric surgery is more effective than non-surgical options; however, postoperative pain is bound to a greater morbidity. Control of postoperative pain is important in facilitating patient convalescence. In this study, we assessed the efficacy of intraperitoneal instillation of bupivacaine after bariatric surgery. A hundred patients who underwent bariatric procedures including sleeve gastrectomy, sleeve gastrectomy with cardioplasty, gastric bypass, and gastric mini bypass (one anastomosis gastric bypass) were included in the study. Patients were divided into two groups randomly, 50 patients for each; group I had intraperitoneal instillation of 40ml bupivacaine 0.25% at the end of the procedure, while group II had normal saline instillation. Monitoring of pain control in the first 24h after surgery was done using the visual analogue scale (VAS) to assess the efficacy of intraperitoneal bupivacaine instillation and its effect on the overall opioid usage, postoperative nausea and vomiting (PONV), and shoulder tip pain. Pain scores were significantly lower in group I compared to group II at recovery, 2, 4 and 6h after surgery, P = 0.004, 0.001, < 0.001, and 0.001 respectively. However, there were no significant differences between 12 and 24h postoperatively. Additionally, there was a significant difference regarding the need for rescue analgesia at recovery P = < 0.001*. Further analysis revealed lower morphine consumption via PCA in group I compared to group II P = 0.013*. There were no significant differences with the use of intraperitoneal bupivacaine as regards nausea, vomiting, or shoulder tip pain, P = 0.688, 0.249, and 0.487, respectively. Intraperitoneal instillation of bupivacaine provides a good analgesia in the early postoperative period, reduces the overall consumption of opioid, and decreases the rescue analgesia requirement in the first 24h after surgery.

A Comparative Study to Assess the Effectiveness of Endotracheal Suctioning with and without Normal Saline Instillation in Terms of Physiological Parameters and Patient Outcome Measures among Mechanically Ventilated Patients in Selected Hospital of New Delhi

Intubated patients are unable to cough sufficiently to remove pulmonary secretion. Nurses occasionally encounter thick and tenacious secretions during endotracheal (ET) suctioning. To manage these secretions, normal saline instillation (NSI) is used throughout the world. The use of NSI before endotracheal suctioning is intended to lubricate the catheter, liquefy and soften secretions, and stimulate coughing. The objectives of the study were to assess the effectiveness of endotracheal suctioning with normal saline instillation in terms of physiological parameters and patient outcome among mechanically ventilated patients; to assess the effectiveness of endotracheal suctioning without normal saline instillation in terms of physiological parameters and patient outcome among mechanically ventilated patients; and to compare the effectiveness in terms of physiological parameters and patient outcome in mechanically ventilated patients with and without normal saline instillation. Methods: A quantitative research approach with comparative descriptive design was used for the study. The study was conducted in Max Super specialty Hospital, Saket and New Delhi. Purposive sampling was used for selecting 60 mechanically ventilated patients, from which 30 had undergone ET suctioning with normal saline instillation and 30 had undergone ET suctioning without normal saline instillation. Physiological parameters were assessed by using an observation checklist. Patient outcomes were assessed through observations made at 0–72 hours. Results: The significant findings of the study revealed that mechanically ventilated patients, who had undergone ET suctioning with NSI in comparison to patients who had undergone ET suctioning without NSI, were significant in terms of ventilator tidal volume at 18 hours, p value was 0.005 (p1), similarly systolic blood pressure at 6 hours and 12 hours were 0.001 and 0.049 respectively, significant at 0.05 level of significance. p value of temperature at 12 hours was 0.031, p values of ABG PaO2 at 0 hour, 6 hours,12 hours and 18 hours were 0.036, 0.005, 0.022 and 0.043 respectively, significant at 0.05 level of significance, p values of ABG Na+ at 6 hours and 12 hours were 0.003 and 0.001 respectively, significant at 0.05 level of significance, p values of ABG K+ at 6 hours were 0.046, p values of ABG Ca++ at 0 hour and 12 hours were 0.044 and 0.045 which were significant at 0.05 level respectively; however, the p2 value calculated by ANOVA test from 0–72 hours of patient outcome was not significant at 0.05 level of significance. Conclusion: The findings of the present study conclude that normal saline instillation while ET suctioning was effective in comparison to ET suctioning without normal saline instillation among mechanically ventilated patients in terms of respiratory parameters.

“When no-one's looking,” the application of lung recruitment and normal saline instillation with paediatric endotracheal suction: An exploratory study of nursing practice

BackgroundThe complex nature of the Paediatric Intensive Care Unit (PICU) patient requires the bedside nurse to make rapid, complex decisions regarding endotracheal suction (ETS) interventions. It is not understood what influences nurses’ decision making in the context of ETS, however, the actions of the clinician have a direct impact on the efficacy of the ETS event and patient outcomes. ObjectivesTo explore and describe the use of normal saline instillation and lung recruitment with paediatric ETS in a cohort of Australian nurses, and to identify factors that influence normal saline use with ETS. MethodsA descriptive, exploratory study. An evidence-based practice model formed the conceptual basis for the study. Semi-structured interviews were conducted with 12 nurses from an Australian tertiary referral paediatric intensive care unit. Audiotaped interviews were transcribed. Inductive thematic analysis was used to code and analyse the interview data and identify themes. FindingsData analysis revealed three themes: patient’s clinical presentation, clinician judgement and unit practice norms. ConclusionsVariability in nurses ETS practice was marked. In the absence of evidence based clinical guidelines, nurses relied on knowledge derived from clinical experience and the local setting to guide NSI and LR intervention decisions. Participants reported uncertainty regarding ETS best practice and perceived the lack of research evidence as a barrier to making informed clinical decisions at the bedside. Rigorous research evaluating the safety and efficacy of NSI and LR with ETS is urgently required for patient care; however PICU nurses rely on multiple sources of evidence to inform ETS practice decision.

Normal saline instillation with paediatric endotracheal suction: It's what's always been taught

Introduction: Normal saline instillation (NSI) with endotracheal suction (ETS) is a controversial practice. While there is growing evidence for the abandonment of this practice in mechanically ventilated adults, there is a dearth of quality evidence to support or refute NSI use in intubated children. This lack of guidance has resulted in variable NSI practices in the paediatric intensive care unit (PICU). It is not understood what factors influence a nurse to apply NSI with ETS, or what perceived effect NSI treatment has on patient outcomes.

Normal saline instillation versus no normal saline instillation And lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction: the NARES trial. A study protocol for a pilot, factorial randomised controlled trial

IntroductionEndotracheal suction (ETS) is a frequent and necessary airway intervention for the intubated child. The aim of ETS is to clear the endotracheal tube and airways of respiratory secretions; however,...

Evaluate the Efficacy and Safety of Normal Saline Instillation in Induction of Mid Trimester Abortions

Evaluate the Efficacy and Safety of Normal Saline Instillation in Induction of Mid Trimester Abortions

V11-06 STEP BY STEP ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A SINGLE HOSPITAL EXPERIENCE

You have accessJournal of UrologyUrolithiasis1 Apr 2017V11-06 STEP BY STEP ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A SINGLE HOSPITAL EXPERIENCE Yite Chiang and Kaiyi Tzou Yite ChiangYite Chiang More articles by this author and Kaiyi TzouKaiyi Tzou More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2995AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy is effective for patient who has large renal stone > 2cm in size. Ultrasound-guided percutaneous nephrolithotomy can be performed safely without radiation exposure. We describe how we performed ultrasound-guided percutaneous nephrolithotomy step by step according to our experience. METHODS We conducted a retrospective study of patients received percutaneous nephrolithotomy from January 2012 to October 2016. In total, 205 patients were enrolled. One-hundred and thirty-six patients received ultrasonic-guide operation and 69 received fluroscopic-guided operation. Patients’ clinical characteristics, operation time, hospital stay, complication, hematocrit and renal function data were recored and analyzed. We performed ultrasound-guided by following steps:(1) Double-J catheter insertion (2) Three-way Foley insertion (3) Normal saline instillation and Foley clumping (4) Needle puncture (5) Incision and Dilatation (6) Balloon dilatation and insert sheath. RESULTS Among two groups, the patient clinical characteristics do not have significant difference. There were also no difference during hospital stay, hematocrit and renal function change. However, shorter operation time (62mins vs. 87mins, p< 0.05), was noted in ultrasound-guided group maybe due to shortened puncture time. In the other hand, complete stag-horn stone patients had higher stone free rate (75% vs 90%, p< 0.05) in fluroscopic group. Complication rate is similar in two groups but one patient in ultrasound-guided group had developed bladder rupture while normal saline instillation by pressure pump. CONCLUSIONS ultrasound-guided percutaneous lithotomy is feasible for patient who has large renal stones. The outcome is similar compared to traditional fluroscopic-guided procedure. In our experience, ultrasound-guide may shorten puncture time and decrease the radiation exposure to patients and staffs. Double-J catheter insertion before puncture to create dilated calyces may help puncture easier. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1283 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yite Chiang More articles by this author Kaiyi Tzou More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Normal saline instillation before endotracheal suctioning: “What does the evidence say? What do the nurses think?”: Multimethod study

PurposeThis study aimed to systematically review studies that investigated the effects of normal saline instillation before endotracheal suctioning and to determine the views of nurses concerning this procedure. MethodsThis study was carried out in 2 stages as a systematic review and a descriptive study. In the first stage, the Medline and CINAHL databases were searched. The second stage of the study consisted of a survey of 65 intensive care nurses. ResultsThe systematic review identified 7 studies. Nearly all of the studies had a self-controlled clinical trial design. Normal saline instillation before endotracheal suctioning was demonstrated to decrease patient oxygenation in most studies (P < .05). However, the impact of normal saline on hemodynamics and the incidence of ventilator-associated pneumonia remain unclear. Most nurses (87.7%) apply normal saline instillation. ConclusionAlthough the effects of normal saline instillation on hemodynamics and pneumonia incidence remain controversial, this procedure significantly decreases the oxygenation. Therefore, the use of this procedure is not recommended. However, normal saline instillation is used frequently by nurses to manage thick and tenacious secretions in clinical practice. Additional studies are needed to determine the effectiveness of applications that may be alternatives to normal saline instillation in the management of these secretions.

Comparative Analysis of Effect of Bupivacaine and Normal Saline Instillation in Gall Bladder Fossa on Pain Following Laparoscopic Cholecystectomy

Comparative Analysis of Effect of Bupivacaine and Normal Saline Instillation in Gall Bladder Fossa on Pain Following Laparoscopic Cholecystectomy

The effect of normal saline instillation on cardiorespiratory parameters in intubated cardiothoracic patients

Objective. The objective of this study was to describe the effect of normal saline instillation (NSI) on cardiorespiratory parameters in intubated cardiothoracic patients. Methods . A comparative design was employed to meet the study objectives. Simple random sampling was used to assign patients to study groups, namely a research group (non-NSI) and a control group (NSI). The data-capturing tool was based on the literature review. Descriptive and comparative statistics were employed to analyse the data. Findings were assessed according to p &lt;0.05. Results. Findings indicated that there were no statistically significant differences in heart rate, blood pressure, arterial partial pressure of oxygen (PaO2), arterial oxygen saturation as measured by blood gas analyser (SaO2) and serum bicarbonate level (HCO3 –) when NSI was used or not used during endotracheal suctioning ( p =0.05). Statistically significant differences were found in pH and patient return rate to baseline arterial oxygen saturation as measured by pulse oximetry (SpO2) after 30 minutes of suctioning: 63.6% of patients in the NSI group failed to return to baseline SpO2 v. 37.5% of patients in the non-NSI group ( χ 2 p =0.035; Fisher’s exact p =0.048). There was a decrease in pH when NSI was used during suctioning. Although these differences were statistically significant, clinically they were not significant. Conclusion. It can be concluded that NSI had no effect on cardiorespiratory parameters in intubated cardiothoracic patients. Even though the patient population was at high risk of haemodynamic disturbance and hypoxia during this manoeuvre, there was no meaningful clinical effect; however, the sample size was too small to establish safety

The effect of endotracheal suctioning using or not using normal saline on respiratory physiologic parameters in open heart surgery patients

Background: Tick and tenacious secretions is one of the problems in suctioning and the instillation of normal saline in airways is one of the ways for removing pulmonary secretions. The aim of this study was to determine the effect of endotracheal suctioning using or not using normal saline on respiratory physiologic parameters in open heart surgery patients. Methods: This study was a one-group clinical approach. The study group consisted of 40 patients receiving mechanical ventilation in the heart ICU after coronary artery bypass graft. Endotracheal suctioning with and without normal saline were carried out on each patient. Respiratory physiologic parameters were measured 1 minute before and 1, 5 and 15 minutes after each suctioning procedure and were recorded in a data collection form. Data was analysed utilizing T test and ANOVA. Results: Respiratory physiologic parameters changed after suctioning in both methods of endotracheal suctioning but no significant difference was found between both methods of suctioning. Conclusion: Suctioning by using normal saline instillation can lead to lower changes in respiratory physiologic parameters compared not using normal saline. Therefore, suctioning with normal saline instillation can increase the procedures efficacy and reduce the possible complication.

Leech Infestation in Children Through Body Orifices: Experience in a Hospital in Bangladesh

Bangladesh harbors many leeches in its vast wetlands. Leeches have a tendency to enter through body orifices with potentially life-threatening consequences. Literature search revealed inadequate description of clinical manifestations and treatment of leech infestations in children. We describe our experience with leech infestations in children. Between January 1, 2004 and December 31, 2010, 17 cases of leech infestation through body orifices in children were managed. This is a retrospective study on age, sex, route of leech entry, investigation and treatment, and outcome. Age ranged from 4.5 to 11 years (mean 6.4 ± 1.8) and females accounted for more than 70 %. The orifices of leech entry include urethra, vagina, and rectum. Leeches could be found in eight cases. Two boys with leeches in the urinary bladder needed suprapubic removal. Leeches were retrieved from the vagina under general anesthesia in three cases, and on three occasions leeches came out from the vagina after normal saline instillation. In nine cases with different routes of entry where leech was not found, instillation of normal saline was sufficient to stop bleeding. Fifteen cases presented with bleeding and transfusion was required in five cases with Hb% <7 gm/dl. Leech infestation through lower body orifices is common in children of rural Bangladesh. Prompt diagnosis is of paramount importance, and application of normal saline is effective in most cases. Sometimes surgical intervention is required.

Oxygen saturation and secretion weight after endotracheal suctioning

Endotracheal suctioning is a common aspect of nursing care to mechanically-ventilated patients. The aim of this study was to investigate the effects of two suctioning techniques on oxygen saturation (SaO2) and the amount of drained secretions. A quasi-experimental study of 103 mechanically-ventilated patients was conducted from two tertiary hospitals in Greece. Two suctioning techniques were applied to each patient: with normal saline instillation and without. Normal saline instillation was associated with increased secretions' weight (p<0.001) and no significant differences in SaO2 values compared with no instillation. In examining each suctioning technique separately, the use of normal saline instillation was associated with a decrease in SaO2 levels 1 minute (p<0.001) and 15 minutes (p=0.002) after this procedure. In addition, suctioning without normal saline instillation was associated with a decrease in SaO2 1 minute (p<0.001) after the suction. In conclusion, normal saline instillation is related with a negative outcome on patient oxygenation for a prolonged period after the suction and causes the removal of a greater amount of secretions than the applied technique with no instillation. Comparing the two techniques, none is superior to the other resulting from the statistically insignificant comparative differences in SaO2 values.

Consensus among Physiotherapists in the United Kingdom on the Use of Normal Saline Instillation Prior to Endotracheal Suction: A Delphi Study

To investigate whether physiotherapists consider normal saline instillation (NSI) useful before endotracheal suctioning and, if so, when. Sixty-eight respiratory physiotherapists recruited from the United Kingdom's Association of Chartered Physiotherapists in Respiratory Care agreed to participate in a Delphi study. Clinicians' opinion of when NSI should be used was established and developed into statements. Level of agreement with each statement was collated through three rounds of a questionnaire. Clinicians' experiences were also reported. From the 52 responses to the third questionnaire, there was consensus that respiratory physiotherapists in the United Kingdom would use NSI when sputum retention is a problem, particularly when treatment options are limited (96%) and when sputum is obstructing the airway (92%). They agreed that non-bronchoscopic bronchoalveolar lavage can be used to resolve persistent atelectasis (70%). They would not use NSI for a test treatment during initial assessment without evidence of retained secretions (94%), when secretions are copious but can be cleared by alternative physiotherapy techniques (96%), to enhance a cough unless very strong evidence indicates retained secretions (81%), or to compensate for inadequate suction technique (90%). This study provides clinicians' views about when NSI could be used.

上顎洞留置チューブを用いた上顎洞炎の治療

Objective: Treatment of maxillary sinusitis with an indwelling tube is not a common method at present. The study examined the efficacy of treatment by puncture and repetitive irrigation of the maxillary sinus using an indwelling tube.Subjects: The subjects consisted of 52 cases (sinuses) of maxillary sinusitis in 51 patients (10 to 80 years old, averaged 52.7 years old) that had not responded at all to pharmacotherapy (including clarithromycin) and nebulized aerosol therapy (cefmenoxime hydrochloride) for more than 1 month after the acute stage. Patients of odontogenic sinusitis or nasal polyp were excluded from this study.Method: The patients were treated by sinus irrigation with normal saline solution (100 to 200ml) and instillation followed by 1% cefmenoxime hydrochloride solution (1ml) in the sinus once daily, using an indwelling tube with SinoJect® (a special device for puncture and irrigation of the maxillary sinus) inserted in the maxillary sinus via the inferior meatus. And the tube was removed when macroscopic observation confirmed recovery of clear washout products. The effects of treatment were also evaluated on X-ray findings obtained 1 to 2 weeks later.Results: 1) Complete response (opacity disappeared) was noted in 21 (40.4%) cases, partial response (opacity was reduced) in 17 (32.7%) cases, and no response in 14 (26.9%) cases. Finally, more than half the patients showing no response underwent endoscopic sinus surgery. 2) The frequencies of the irrigation ranged 2 from 19 times and averaged 3.9 times. 3) Puncture and irrigation was performed very easily and safely. There was no significant complication in any patient.Conclusion: The results suggested that repetitive irrigation with an indwelling tube is a useful treatment method for intractable maxillary sinusitis.

JTE-607, a cytokine release blocker, attenuates acid aspiration-induced lung injury in rats

The present study was designed to clarify the effects of (-)-ethyl N-{3,5-dichloro-2-hydroxy-4-[2-(4-methyl-piperazin-1-yl)ethoxy]benzoyl}- l-phenylalaninate dihydrochloride (JTE-607), a novel multiple cytokine inhibitor, on hydrochloric acid (HCl) aspiration lung injury in rats. HCl (0.1 N, 2 ml kg −1) was instilled into male Sprague–Dawley rats that were pretreated with or without JTE-607 (30 or 75 mg kg −1 h −1). As a control, normal saline (2 ml kg −1) was instilled in rats. All the animals were anesthetized with intraperitoneally injected pentobarbital sodium (40 mg kg −1). Bronchoalveolar lavage was performed 5 h (h) after HCl or normal saline instillation. In bronchoalveolar lavage fluid, the increases in total nuclear cell counts, neutrophil counts, optical density at 412 nm as an indication of pulmonary hemorrhage, concentrations of albumin, tumor necrosis factor (TNF)-α, interleukin (IL)-6 and cytokine-induced neutrophil chemoattractant induced by HCl instillation were significantly reduced by JTE-607 pretreatment. The level of expression of tumor necrosis factor-α and interleukin-6 mRNA in lung tissue was analyzed. The mean expression level of tumor necrosis factor-α and interleukin-6 mRNA in the JTE-607 group was lower than that in the HCl and NS groups. The wet-to-dry weight ratio was also determined, and JTE-607 at the dose of 75 mg kg −1 h −1 significantly attenuated the increased wet-to-dry weight ratio induced by HCl. These results suggest that JTE-607 can inhibit the production of inflammatory cytokines such as tumor necrosis factor-α, interleukin-6 and cytokine-induced neutrophil chemoattractant and attenuate acid-induced lung injury in rats. This agent might be therapeutically useful for lung injury.

Utilization of the Iowa Modelin establishing evidence-based nursing practice

Clinical practice based on tradition or established rituals appears to be widespread amongst avariety of nurses and practice settings. However, tradition-based practice may not necessarily be based on sound scientific evidence and could potentially be harmful to patients or result in inappropriate utilization of resources. Conversely, evidence-based practice is the utilization of the best available empirical evidence in the practice setting, to facilitate sound clinical decision-making. Suctioning ventilated patients is a necessary and important aspect of patient care. However, normal saline instillation prior to suctioning, in order to loosen secretions, remains a common nursing procedure despite research suggesting that there is no clear benefit and in some instances may be harmful. Several models have been developed over the past few years to facilitate nursing practice that is based on research or the best available evidence. The Iowa Model, developed at the University of Iowa Hospitals and Clinics, serves as a framework to improve patient outcomes, enhance nursing practice and monitor health care costs. Moreover, it facilitates the application of empirical evidence to clinical practice. This paper will discuss the utilization of the Iowa Model to promote evidence-based nursing practice, with regard to normal saline instillation prior to suctioning, in the critical care unit of a 100-bed hospital in Hong Kong. Patient, staff and fiscal outcomes will also be reported.

Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm).

Normal saline instillation, in conjunction with endotracheal suctioning, is purported to be beneficial in removing thick and tenacious secretions for patients receiving mechanical ventilation. Guidelines for this routine procedure are inconsistent and its efficacy is unsupported by research-based evidence. This discussion paper highlights that the procedure produces no physiological benefits for the patient and, indeed, may have detrimental effects on the patient's psychological wellbeing. It is proposed that after 25 years of inconsistent practice in trying to remove thick and tenacious secretions, it is time to focus on techniques to prevent thick and tenacious secretions.

Endotracheal suctioning in adults with severe head injury: literature review.

Endotracheal suctioning is a routine but potentially dangerous nursing procedure. The research literature documenting approaches to minimising the complications of endotracheal suctioning in adults with severe head injuries is reviewed. Hyperoxygenation, hyperventilation, hyperinflation, normal saline instillation and the effects of endotracheal suctioning on intracranial pressure and cerebral perfusion pressure are examined. Recommendations for an evidence-based endotracheal suctioning protocol are made.