Neurocritical Care

, Volume 30, Issue 2, pp 364–371 | Cite as

Intraosseous Administration of 23.4% NaCl for Treatment of Intracranial Hypertension

  • Jing Wang
  • Yun Fang
  • Subhashini Ramesh
  • Asma Zakaria
  • Maryann T. Putman
  • Dan Dinescu
  • James Paik
  • Romergryko G. Geocadin
  • Pouya Tahsili-Fahadan
  • Laith R. AltaweelEmail author
Original Article



Prompt treatment of acute intracranial hypertension is vital to preserving neurological function and frequently includes administration of 23.4% NaCl. However, 23.4% NaCl administration requires central venous catheterization that can delay treatment. Intraosseous catheterization is an alternative route of venous access that may result in more rapid administration of 23.4% NaCl.


Single-center retrospective analysis of 76 consecutive patients, between January 2015 and January 2018, with clinical signs of intracranial hypertension received 23.4% NaCl through either central venous catheter or intraosseous access.


Intraosseous cannulation was successful on the first attempt in 97% of patients. No immediate untoward effects were seen with intraosseous cannulation. Time to treatment with 23.4% NaCl was significantly shorter in patients with intraosseous access compared to central venous catheter (p < 0.0001).


Intraosseous cannulation resulted in more rapid administration of 23.4% NaCl with no immediate serious complications. Further investigations to identify the clinical benefits and safety of hypertonic medication administration via intraosseous cannulation are warranted.


Intraosseous cannulation Central venous catheter Intracranial hypertension Brain herniation Hypertonic saline 



The authors gratefully acknowledge the clinical support from all the nursing staff at the Emergency Department and Neuroscience Intensive Care Unit of Inova Fairfax hospital, as well as Ann K Aizon and Tricia Brannon, Clinical Research Coordinators from Department of Research, Inova Neurosciences, for their unconditional support.

Authors Contribution

JW and LA were involved in study concept and design. All authors contributed to acquisition, analysis, and interpretation of data. YF and JP contributed to statistical analysis. JW, LA, and PT-F were involved in drafting of the manuscript

Source of Support

This study was not funded.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Jing Wang
    • 1
  • Yun Fang
    • 1
  • Subhashini Ramesh
    • 1
  • Asma Zakaria
    • 1
  • Maryann T. Putman
    • 1
  • Dan Dinescu
    • 1
  • James Paik
    • 1
  • Romergryko G. Geocadin
    • 2
  • Pouya Tahsili-Fahadan
    • 1
    • 2
  • Laith R. Altaweel
    • 1
    • 3
    Email author
  1. 1.Neuroscience Intensive Care Unit, Medical Critical Care Service, Department of MedicineINOVA Fairfax HospitalFalls ChurchUSA
  2. 2.Neurocritical Care Unit Division, Department of NeurologyJohns Hopkins UniversityBaltimoreUSA
  3. 3.Neuroscience Research, Neuroscience and Spine InstituteINOVA Fairfax HospitalFalls ChurchUSA

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