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Old 10-15-2008, 12:43 PM
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alizesmom alizesmom is offline
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Default Using saline bullets

Depending on the situation, we will instill saline by neb, ambu it in or just drop it down the trach. I notice that sometimes I can drop the whole bullet (all 3ml) down Alize and he doesn't react at all. I may have to wait several minutes before he coughs it out. Anyone else see this? Have you heard anything about instilling saline that I may not be aware of? Just curious. Karen
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Old 10-15-2008, 12:52 PM
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ha! our nurses told us any more than a ml and we were at risk of drowning her! perhaps something of a scare tactic.

i try to make sure the saline is a small enough amount to stay in the tube only, to loosen what's stuck there

i didn't know you could put it right down, so interested to see the responses to your post.
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Old 10-15-2008, 02:20 PM
kshell kshell is offline
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Our hospital was very strict with using saline down the trach. I'm sure you read my posts before that they actually don't even use it to suction, only to clear the suction cath. We only use saline nebs and have used 1 -2 drops down her trach in an emergency. One of the theories as to why Natalie's lungs were so bad is that the NICU Natalie was born at rountinely used and entire bullet prior to suctioning because she was "thick". Her pulmonologist's theory is you never get all that saline out an it just "sat" in her lungs casuing her to be more at risk for infection. All that being said every child is different. I have found there is a huge difference in teaching with the use of saline. I am interested to see what other people have been told.

Karen
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[SIGPIC]Karen----Mom to Faith (6), and Natalie born 10/12/07 @ 25 weeks, 1lb 3oz. Came home 6/10/08 with a trach, vent, nissen with g-tube, and pda ligation. BPD, reflux, subglottic stenosis. Off the vent!!!! Double stage ltp 5/10. Decan 5/11/11!
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Old 10-15-2008, 05:08 PM
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On the very rare occasion that Luke gets thick we use a few drops (maybe 3-5) then suction and repeat if necessary. He also coughs all the time, so we don't get much down before he coughs it back up. A whole bullet sounds like a lot at once - surprising that Alize doesn't cough more quickly.

When you give saline by neb do you just put the bullet in the nebulizer? We have only used albuterol that way and then only a few times.
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Mom of Sam & Gus (9 yo twins) and Luke (born 2/17/07 with CHARGE syndrome - choanal atresia (14 surgeries to open his nose - and counting), hearing loss & developmental delay, trached at 6 days old because his nose was blocked with bone, later diagnosed with subglottic stenosis and laryngotracheomalacia, g-tube placed at 18 months, tonsillectomy 10/08/09, unexpected decan 1/14/10 , now on CPAP for sleep apnea)
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Old 10-15-2008, 07:40 PM
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We're big saline users in our house. In all the same ways -nebs, ambuu, or just straight into the trach. We usually only use it as a neb if she's sick. Our pulmonology team often tells us to ambuu w/saline during suctioning - especially so when she's sick. She will sometimes react w/a great cough if I just drop it in the trach, and similar to Alize, there are times when there is no reaction.
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Old 10-15-2008, 09:41 PM
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As far as nebs, we just put a bullet in. In fact we often just add it along with the pulmicort on a routine basis. I was told that ambuing it in will get it deeper into the lungs. I was just never told an amount and I know a few drops just don't work with Alize. Keep the good information coming. Karen
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Old 10-15-2008, 09:49 PM
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With Elijah some times we use saline nebs if I can't keep his trach collar on him for very long. As for drops down the trach we were never told a certain amount and very seldom he coughs after a few drops and most of the time it takes the whole vial.
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Old 10-15-2008, 10:27 PM
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I think the whole "it'll just stay inthe lungs and cause sickness" is a scare tatic. The pH of the saline is the ssame as the body produces. Extra saline should be absorbed into the body stright aaway. Deb
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Old 10-16-2008, 04:58 AM
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We were told the same as clare, never more than 1ml. it probably is just scare tactics. We usually instill 0.5ml using a 2ml syringe, then suction, we will then instill another 0.5ml and if the trach is still blocked we go straight to a tube change. We do occasionally use saline nebs when he is really thick, though I have to say, plugs never really seem to bother Sam these days - I guess that's a sign that he is using his nose and mouth some, too

Julie x
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Old 10-16-2008, 12:36 PM
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Wow! I always wondered about this topic. We use the saline bullets right into his trach when Rye gets dry. Sometimes he only needs a few drops before he coughs other times I can use have a vial with no cough! It's never the same. It's good to know he's not the only one, but has any one heard if it's a bad thing to put that much saline down?
Renee
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