Peripheral 3-7.5% Hypertonic Saline
There are still pharmacies that believe that 3% Hypertonic Saline can only be given through a central line. The evidence would go against this assertion:
- Brenkert TE et al. Intravenous Hypertonic Saline Use in the Pediatric Emergency Department (Pediatr Emer Care 2013;29: 71Y73)
- Bulger, Eileen M, Susanne May, Karen J Brasel, Martin Schreiber, Jeffrey D Kerby, Samuel A Tisherman, Craig Newgard, et al. 2010. Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. JAMA, no. 13 ( 6). doi:10.1001/jama.2010.1405. http://www.ncbi.nlm.nih.gov/pubmed/20924011.
- Bulger, Eileen M, Susanne May, Jeffery D Kerby, Scott Emerson, Ian G Stiell, Martin A Schreiber, Karen J Brasel, et al. 2011. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial. Annals of surgery, no. 3. doi:10.1097/SLA.0b013e3181fcdb22. http://www.ncbi.nlm.nih.gov/pubmed/21178763.
- Cooper, D James, Paul S Myles, Francis T McDermott, Lynette J Murray, John Laidlaw, Gregory Cooper, Ann B Tremayne, Stephen S Bernard, and Jennie Ponsford. 2004. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA, no. 11 ( 17). http://www.ncbi.nlm.nih.gov/pubmed/15026402.
- Dubick, M A, and C E Wade. 1994. A review of the efficacy and safety of 7.5% NaCl/6% dextran 70 in experimental animals and in humans. The Journal of trauma, no. 3. http://www.ncbi.nlm.nih.gov/pubmed/7511708.
- Hands, R, J W Holcroft, P R Perron, and G C Kramer. 1988. Comparison of peripheral and central infusions of 7.5% NaCl/6% dextran 70. Surgery, no. 6. http://www.ncbi.nlm.nih.gov/pubmed/2453936.
- Marko, Nicholas F. 2012. Hyperosmolar therapy for intracranial hypertension: time to dispel antiquated myths. American journal of respiratory and critical care medicine, no. 5 ( 1). doi:10.1164/rccm.201109-1698ED. http://www.ncbi.nlm.nih.gov/pubmed/22383562.
- Mattox, K L, P A Maningas, E E Moore, J R Mateer, J A Marx, C Aprahamian, J M Burch, and P E Pepe. 1991. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Annals of surgery, no. 5. http://www.ncbi.nlm.nih.gov/pubmed/1708984.
- Sood L et al. Hypertonic Saline and Desmopressin: A Simple Strategy for Safe Correction of Severe Hyponatremia (Am J Kidney Dis. 61(4):571-578)
- Timmer, J G, and H G Schipper. 1991. Peripheral venous nutrition: the equal relevance of volume load and osmolarity in relation to phlebitis. Clinical nutrition (Edinburgh, Scotland), no. 2. http://www.ncbi.nlm.nih.gov/pubmed/16839898.
- J Intensive Care Med. 2018 Jan;33(1):48-53. doi: 10.1177/0885066617702590. Epub 2017 Apr 4.
- https://doi.org/10.1016/j.ajem.2022.10.051
- https://doi.org/10.1016/j.ajem.2023.04.007
If they ask for a Pharmaceutical Reference, give them this one:
AHFS Drug Information 2008
Peripheral 23.4%
(all of the following are PMID #s)
i am mostly certain all of them are a repeat of the above list
- [cite source=’pubmed’]22383562[/cite]
- [cite source=’pubmed’]1708984[/cite]
- [cite source=’pubmed’]2453936[/cite]
- [cite source=’pubmed’]16839898[/cite]
- [cite source=’pubmed’]7511708[/cite]
- [cite source=’pubmed’]20924011[/cite]
- [cite source=’pubmed’]21178763[/cite]
- [cite source=’pubmed’]15026402[/cite]
Given by a peripheral route in our ED. No argument here Scott.
What max rate via peripheral line have you noticed?
Good resource, thanks. I’ve had to place central lines before because of misconception. Though of course I’d argue look at the clinical scenario. If the patient is comatose, has cerebral edema, etc, you may want to have the central line, anyway.