What are the indications for 0.9% sodium chloride (normal saline) for a respiratory therapist?

From the Guidelines

0.9% sodium chloride is indicated for use by respiratory therapists to assist with physiotherapy and as a diluent for nebulized medications, as well as for sputum induction and bronchial washing during bronchoscopy procedures. The use of 0.9% sodium chloride is supported by guidelines from the British Thoracic Society, which recommend its use to assist with physiotherapy 1. Additionally, the British Thoracic Society guideline for bronchiectasis in adults suggests the use of isotonic (0.9% saline) or hypertonic saline to evaluate effectiveness pre-airway clearance, especially in patients with viscous secretions or evidence of sputum plugging 1. The American Thoracic Society also recommends the use of sterile normal saline (0.9% sodium chloride) as a diluent for methacholine challenge testing 1.

Some key points to consider when using 0.9% sodium chloride include:

• Using sterile normal saline to minimize the risk of contamination and infection
• Ensuring proper patient positioning and explaining the procedure to the patient
• Monitoring for adverse reactions, such as bronchospasm, although these are rare with normal saline
• Using 0.9% sodium chloride as a diluent for nebulized medications, such as bronchodilators and mucolytics
• Considering the use of 0.9% sodium chloride for sputum induction and bronchial washing during bronchoscopy procedures.

It's worth noting that the most recent and highest quality study, 1, provides guidance on the use of 0.9% sodium chloride in the context of bronchiectasis, and its recommendations should be prioritized in clinical practice.

From the Research

Indications for 0.9% Sodium Chloride

• 0.9% sodium chloride, also known as normal saline, is commonly used in respiratory therapy for various indications, including:
  • Nebulization to help loosen and clear mucus from the airways 2
  • Nasal irrigation to promote mucociliary clearance and reduce symptoms of respiratory infections 3
• The use of 0.9% sodium chloride in respiratory therapy is supported by several studies, which have shown its effectiveness in:
  • Reducing symptoms of bronchiolitis in children 2
  • Improving respiratory distress scores in patients with acute bronchiolitis 4
  • Reducing hospitalization rates for bronchiolitis in children 3

Comparison with Hypertonic Saline

• Hypertonic saline (3%) has been compared to 0.9% sodium chloride in several studies, with mixed results:
  • One study found that nebulized hypertonic saline was not more effective than normal saline in improving respiratory distress scores in patients with acute bronchiolitis 4
  • Another study found that nebulized hypertonic saline was as effective as normal saline and salbutamol in treating acute bronchiolitis in a tertiary hospital 2
• The choice between 0.9% sodium chloride and hypertonic saline may depend on the specific clinical context and patient population:

Role of Respiratory Therapists

• Respiratory therapists play a crucial role in the administration of aerosol therapy, including 0.9% sodium chloride:
  • A study found that the use of respiratory therapist-driven protocols for aerosol therapy can reduce resource utilization and costs compared to physician-ordered treatments 5
  • Respiratory therapists can assess patient clinical status and recommend adjustments to aerosol therapy, including the use of 0.9% sodium chloride 5