Intubated patients are unable to cough sufficiently to remove
pulmonary secretions. In such cases, the retention of secretions causes
atelectasis and insufficient ventilation. Thus, endotracheal suctioning
is an important nursing practice for intubated patients [1]. Nurses
occasionally encounter thick and tenacious secretions during endotracheal
suctioning. To manage these secretions, normal saline instillation
(NSI) is used throughout the world [2-4]. The use of NSI before endotracheal
suctioning is intended to lubricate the catheter, liquefy and soften
secretions, and mobilize secretions by stimulating coughing [5,6].