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Administration of 3% Sodium Chloride Through Peripheral Intravenous Access: Development and Implementation of a
Gemi E Jannotta1, Bernice G Gulek1,2, John S Dempsey3
1Neurocritical Care Service, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Peripherally infused 3% sodium chloride is safe for augmenting serum sodium levels in patients with severe hyponatremia. This evidence-based protocol reduced adverse events associated with central venous catheters.
Area of Science:
- Critical Care Medicine
- Nephrology
- Emergency Medicine
Background:
- Patients with traumatic brain injury, cerebral edema, and severe hyponatremia need rapid serum sodium level augmentation.
- Three percent sodium chloride is commonly used, but optimal administration route lacks data.
- Central venous catheters (CVCs) carry risks; peripheral infusion may mitigate these.
Purpose of the Study:
- To explore evidence for peripheral infusion of 3% sodium chloride.
- To implement an evidence-based protocol for peripheral administration.
Main Methods:
- Utilized the Iowa Model of Evidence-Based Practice (EBP).
- Established a multidisciplinary team to develop a protocol for peripheral intravenous catheter (PIV) administration.
- Implemented targeted education in a large academic medical center.
Main Results:
- 103 patients were included in the project.
- Only three (2.9%) adverse events were identified.
- Two events occurred with continuous infusions, one with a bolus infusion.
Conclusions:
- This study details the first multidisciplinary protocol for peripheral 3% sodium chloride administration.
- Multidisciplinary teams are crucial for successful EBP implementation.
- An evidence-based PIV protocol can reduce CVC-related adverse events.
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