Safety and Efficacy of 3% Hypertonic Saline Bolus Via Peripheral Intravenous Catheter for Neurological Emergencies

Abstract

Abstract Background: Elevated intracranial pressure (ICP) is a neurological emergency in patients suffering from acute brain injuries. Such a state requires immediate and effective interventions to prevent potential neurological deterioration. Current clinical guidelines recommend hypertonic saline (HTS) and mannitol as first-line therapeutic agents. Notably, HTS is conventionally administered through central venous catheters (CVC), which may introduce delays in treatment due to the complexities associated with CVC placement. These delays can critically affect patient outcomes, necessitating the exploration of more rapid therapeutic avenues. This study aimed to investigate the safety and efficacy of administering rapid boluses of 3% HTS via peripheral intravenous (PIV) catheters. Methods: A retrospective cohort study was performed on patients admitted to SSM Health Saint Louis University Hospital from March 2019 to September 2022 who received at least one 3% HTS bolus via PIV at a rate of 999 mL/hour for neurological emergencies. Outcomes assessed included complications related to 3% HTS bolus and its therapeutic effects as determined by changes in ICP, sodium, chloride, and serum osmolality. Results: Out of 216 3% HTS boluses administered in 124 patients, complications occurred in 8 administrations (3.7%). Pain at injection site (4 administrations; 1.9%) and thrombophlebitis (3 administrations; 1.4%) were most common. The median ICP reduced by 4.6 mmHg after 3% HTS bolus, with significant increases in serum sodium, chloride and osmolality (all p < 0.001). Conclusions: Rapid bolus of 3% HTS via PIV presents itself as a relatively safe and efficacious approach, with a compellingly low rate of complications. Its implementation could provide an invaluable alternative to the traditional CVC-based administration, potentially minimizing CVC-associated complications and expediting life-saving interventions for patients with neurological emergencies.