Jordan Journal of Nursing Research
Normal Saline Instillation at Neonatal Intensive Care Units: A Descriptive Study of Neonatal Nurses' Knowledge and Practice


Manal Kassab; Manal Kassab; Rachel Joseph; Shereen Hamadneh; Doaa Rababaah,;


Background: Instillation of normal saline (NS) during endotracheal suctioning is a common practice in neonatal intensive care units in Jordan, while in most developed countries, this is not a standard of care Objectives: The objective of the present study was to examine the suctioning practice of NICU nurses in six hospitals in Jordan, with particular attention to the use of NS. The present study aimed to determine why NICU nurses continue to instil normal saline during suctioning. The study also explored current NSI instillation and suctioning techniques in selected settings. Methods: A cross-sectional descriptive approach was used to collect data from 136 NICU nurses using a 29-question, self-administered questionnaire. The participants were from seven NICUs of seven governmental hospitals in Jordan. The questionnaire addressed tracheal suctioning practices within the NICU. Results: Findings show a higher frequency of use of NS in NICU. Most nurses (79.41%) believed that NS is beneficial for loosening secretions, stimulating cough response (57.8%), promoting neonate comfort (57%), and helping to reduce bacterial growth (41.5%). Most nurses (94.8%) instilled not more than 0.5 ml of NS during the suctioning procedure. Most nurses (80%) used open suctioning rather than closed suctioning, and 80.5% of nurses instilled the NSI in the endotracheal tube rather than the in-line suction adapter. The NICU nurses' level of knowledge and their practices regarding acceptable suction pressure varied. The vast majority (82%) believed it should be less than 80 mmHg of intermittent suctioning. More than half of participants (53.7%) reported that they suction mechanically ventilated premature neonates more frequently than is necessary. Participants indicated that a significant complication associated with NS use included increased pulmonary infection (41.6%) and decreased oxygen saturation (42.1%). Conclusion: This is the first study that explored neonatal nurses' knowledge and practice of NS use during endotracheal suctioning in premature neonates in a developing country. Instillation of NS during suctioning could be detrimental to the health of premature neonates. Jordanian NICU nurses should be educated on best endotracheal suction practices, particularly NS instillation. Evidence-based practice guidelines should be updated to facilitate safe suctioning practice in Jordanian NICUs.


Normal saline instillation, suctioning, endotracheal tube, NICU, developing country.