Q: In my practice, I use 3 mL normal saline for lavage, then use a manual resuscitation bag and suction to get all the mucus out. Current practice states not to use lavage, only suctioning. In doing so, I find patients are having the airway occluded by mucous plugs. Kindly advise.

A: Maureen A. Seckel, RN, APN, ACNS-BC, CCNS, CCRN, replies:

You are correct that current evidence-based practice for suctioning an artificial airway does not recommend lavage or instillation of normal (0.9%) saline as a routine method for removing mucus.1–3  No research supports the use of normal saline for routine suctioning. Normal (0.9%) saline has not been shown to thin mucus or to remove or prevent formation of mucous plugs, and it may cause a decrease in arterial and venous oxygenation along with other potential harmful complications including increased risk...

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