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There is evidence against instilling saline into tracheostomies before suctioning. 1 If readers go to http://www.pubmed.gov and search for "suctioning and saline," they will find many articles on the topic. Most of these examine the added physiologic distress that it imposes on patients 2-4 (including children 5), but others demonstrate that the saline is actually washing microorganisms from the inside of the trach into the lungs, 6, 7 putting the patient at greater risk for pneumonia. There is no evidence that the saline actually loosens secretions-the thickest secretions are unaffected by a quick wash of saline, and the saline doesn't reach most of these secretions. Blackwood concludes, "It is proposed that after 25 years of inconsistent practice in trying to remove thick and tenacious secretions, it is time to focus on ways to prevent thick and tenacious secretions." 8
REFERENCES
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