Normal saline has been widely used in acute care settings during endotracheal and tracheostomy suctioning. Clinicians have held fast to this longstanding tradition because many were taught that normal saline breaks up secretions and aids in their removal (especially tenacious secretions). In this clinical review, we summarize current evidence related to the following questions: Does instilling normal saline during suctioning increase sputum yield? Alternatively, is this practice associated with adverse physiological and psychological effects?

The strategy included searching MEDLINE, CINAHL, Cochrane Library, Joanna Briggs Institute, and TRIP databases. Key words included endotracheal tubes, tracheostomies, normal saline, and suctioning. All types of evidence (nonexperimental, experimental, qualitative studies, systematic reviews) were included.

In the past 2 decades, investigators have studied the physiological and psychological effects of instillation of normal saline. The impact of the instillation of normal saline on sputum...

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