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Safety of peripherally administered 3% hypertonic saline
Robert F Deveau1, Kaylee K Marino1, Kaitlin E Crowley1
1Department of Pharmacy, Brigham and Women's Hospital, Boston, MA 02115, USA.
The American Journal of Emergency Medicine
|November 13, 2022
Summary
Peripheral administration of 3% sodium chloride is linked to infusion-related adverse events (IRAE), primarily mild phlebitis or infiltration. Longer infusion durations increase IRAE risk, suggesting short peripheral administration may be safe in acute care settings.
Area of Science:
- Clinical Pharmacy
- Critical Care Medicine
- Vascular Access
Background:
- High osmolarity of 3% sodium chloride poses risks for infusion-related adverse events (IRAE).
- Hospital policies often mandate central line administration due to safety concerns and limited data on peripheral use.
- Peripheral administration of 3% sodium chloride requires further safety evaluation.
Purpose of the Study:
- To assess the incidence of IRAE during peripheral administration of 3% sodium chloride.
- To identify risk factors associated with IRAE in patients receiving peripheral 3% sodium chloride.
Main Methods:
- Retrospective analysis of 706 administrations of 3% sodium chloride via peripheral venous catheter (May 2017 - August 2019).
- IRAE defined as documented infiltration or phlebitis.
- Multivariable logistic regression used to identify risk factors including age, infusion rate, duration, catheter location, and needle gauge.
Main Results:
- 10.5% of administrations (74/706) resulted in a documented IRAE.
- 48% of IRAE events were Grade 1 severity (mild).
- Increased infusion duration was significantly associated with higher odds of IRAE (OR 1.02 per hour). Age, infusion rate, catheter location, and needle gauge were not independent risk factors.
Conclusions:
- IRAEs are more frequent with longer infusion durations of 3% sodium chloride.
- Most IRAEs are mild and do not cause permanent tissue injury.
- Short-duration peripheral administration of 3% sodium chloride may be considered in acute care, pending further research.
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