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Safety and Effect on Intracranial Pressure of 3% Hypertonic Saline Bolus Via Peripheral Intravenous Catheter for Neurological Emergencies

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Abstract

Background

Elevated intracranial pressure (ICP) is a neurological emergency in patients with 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 (CVCs), 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 effect on ICP of administering rapid boluses of 3% HTS via peripheral intravenous (PIV) catheters.

Methods

A retrospective cohort study was performed on patients admitted to Sisters of Saint Mary 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 effect on ICP.

Results

Of 216 3% HTS boluses administered in 124 patients, complications occurred in 8 administrations (3.7%). Pain at the injection site (4 administrations; 1.9%) and thrombophlebitis (3 administrations; 1.4%) were most common. The median ICP reduced by 6 mm Hg after 3% HTS bolus administration (p < 0.001).

Conclusions

Rapid bolus administration of 3% HTS via PIV catheters presents itself as a relatively safe approach to treat neurological emergencies. 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, especially in the field and emergency department settings.

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Authors and Affiliations

  1. Department of Neurology, Saint Louis University, St. Louis, MO, USA

    Farid Khasiyev, Abdullah Hakoun, Kara Christopher & Fajun Wang

  2. Department of Pharmacy, Sisters of Saint Mary Health Saint Louis University Hospital, 1008 S. Spring Ave, St. Louis, MO, 63110, USA

    James Braun

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  1. Farid Khasiyev
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  2. Abdullah Hakoun
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  3. Kara Christopher
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  5. Fajun Wang
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Contributions

FK: acquisition and interpretation of data, draft of manuscript; AH: acquisition and interpretation of data, draft of manuscript; KC: analysis and interpretation of data, revision of manuscript critically for important intellectual content; JB: conceptualization of study design, interpretation of data, revision of manuscript critically for important intellectual content; FW: conceptualization of study design, analysis and interpretation of data, revision of manuscript critically for important intellectual content.

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Correspondence to Fajun Wang.

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The authors declare no conflicts of interest.

Ethical Approval/Informed Consent

This study was approved by Saint Louis University Institutional Review Board, and informed consent was waived given the nature of the retrospective study.

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Khasiyev, F., Hakoun, A., Christopher, K. et al. Safety and Effect on Intracranial Pressure of 3% Hypertonic Saline Bolus Via Peripheral Intravenous Catheter for Neurological Emergencies. Neurocrit Care (2024). https://doi.org/10.1007/s12028-024-01941-3

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  • DOI: https://doi.org/10.1007/s12028-024-01941-3

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