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can 3 sodium chloride be given peripherally

by Lucinda Hammes Published 9 months ago Updated 4 months ago
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In clinical practice, sodium chloride 3% is commonly administered through peripheral venous catheters (PVCs) given the necessity of timely administration. However, there is no published data on the safety of administering sodium chloride 3% through PVCs in the adult population.

3% NaCl should be administered through a CVAD if one is already in place. In the absence of a CVAD, multiple studies suggest it is safe to administer 3% NaCl in a peripheral vein to treat severe hyponatremia in situations in which a delay in therapy could result in neurologic complications.

Full Answer

Can 3% (hypertonic) sodium chloride be given through a peripheral IV?

“Episode 368: Can 3% (hypertonic) sodium chloride be given through a peripheral IV?” — pharmacyjoe.com | Critical Care | Hospital Pharmacy | PGY-1 Pharmacy Residency Infusions of 3% sodium chloride are routinely recommended to be given through central, not peripheral IV lines.

How much sodium chloride should be given through a central line?

According to Infusion Nursing: An evidence- based approach 3rd edition - (Mary Alexander, Ann Corrigan, Lisa Gorski, Judy Hankins, Roxanne Perucca) the recommendation is to administer 3% sodium chloride in an ICU setting and through a central line.

What is 3% sodium chloride (NaCl)?

Three percent sodium chloride (3% NaCl) is a hyperosmolar agent that can be lifesaving for patients with severe hyponatremic encephalopathy, traumatic brain injury, and cerebral edema. Until recently, many institutions restricted the infusion of 3% NaCl to a central venous site to avoid infusion related adverse events (IRAEs) in peripheral veins.

Do we need a central catheter for 3% sodium chloride infusions?

Conclusion: Current recommendations that a central catheter is required for continuous intravenous infusion of 3% sodium chloride solution should be reevaluated. Only a few patients who had peripheral infusions had infusion-related reactions.

How many children received 3% NaCl?

What gauge is used to administer 3% NaCl?

Why is 3% NaCl used in a CVAD?

Why is it important to base practice on the most currently available evidence?

When to administer 3% NaCl?

What are the most important assessments during the administration of 3% NaCl?

What is the benefit of Bolus therapy?

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3% Sodium Chloride-PIV or Central Line | IV-Therapy.net

A recurring issue has come about in regards to the best vascular access delivery of 3% Sodium chloride. According to Infusion Nursing: An evidence- based approach 3rd edition -(Mary Alexander, Ann Corrigan, Lisa Gorski, Judy Hankins, Roxanne Perucca) the recommendation is to administer 3% sodium chloride in an ICU setting and through a central line.However, our renal group of doctors feel that ...

Administration of 3% sodium chloride through peripheral IV access

"This is the first study to describe a multidisciplinary protocol development and implementation process for the administration of 3% sodium chloride peripherally" Jannotta et al (2021).

Administration of 3% Sodium Chloride Through Peripheral Intravenous ...

Background. Patients with traumatic brain injury, cerebral edema, and severe hyponatremia require rapid augmentation of serum sodium levels. Three percent sodium chloride is commonly used to normalize or augment serum sodium level, yet there are limited data available concerning the most appropriate route of administration.

Sodium chloride 3% Intravenous INFUSION for Adults (hypertonic saline 3 ...

Who can administer. Administration RESTRICTED - see Appendix 1. Important information. Hypertonic saline may only be used in consultation with a consultant intensivist, consultant endocrinologist, or consultant nephrologist (ref 2); Not for use at ward level - for critical care units only

Peripheral 3% Hypertonic Saline is Safe - EMCrit Project

Peripheral 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 […]

Administration of 3% Sodium Chloride Through Peripheral ... - PubMed

This is the first study to describe a multidisciplinary protocol development and implementation process for the administration of 3% sodium chloride peripherally. Utilizing a multidisciplinary team is critical to the success of an EBP project. Implementing an evidence-based PIV protocol with stringe …

How long does sodium chloride infusion last?

Most (157 patients, 73.7%) received their entire treatment peripherally, for a median duration of 44 hours, 3 minutes. The most common electrolyte abnormalities were hyperchloremia in 49.3% and hypokalemia in 46.9% of patients. At one of the hospitals the maximum peripheral infusion rate was 30 mL/hr, and at the other hospital, it was 75 mL/hr.

How much sodium chloride is given in a patient without central venous access?

The study was done to evaluate the safety of a hospital policy change that allowed the administration of 3% sodium chloride via 16- to 20-gauge peripheral IVs to a maximum infusion rate of 50 mL/hr in patients without central venous access.

Is 3% sodium chloride a peripheral infusion?

Taken together, I think that these studies support the peripheral infusion of 3% sodium chloride in patients who do not already have central venous access.

Is a central catheter required for continuous intravenous infusion of 3% sodium chloride solution?

Current recommendations that a central catheter is required for continuous intravenous infusion of 3% sodium chloride solution should be reevaluated. Only a few patients who had peripheral infusions had infusion-related reactions. Electrolyte abnormalities occurred frequently with peripheral infusion, but the clinical importance of the abnormalities remains unclear.

Is 3% sodium chloride IV?

Infusions of 3% sodium chloride are routinely recommended to be given through central, not peripheral IV lines. This recommendation is based on the theory that since the osmolarity of 3% sodium chloride exceeds 900 mOsm/L, it puts the patient at risk of thrombophlebitis, tissue necrosis, and extravasation reactions.

Is 3% HTS a serious complication?

Although central venous infusion may reduce the risk of these minor complications, it may increase the risk of more serious complications such as large vessel thrombosis, bloodstream infection, pneumothorax, and arterial injury. The concern regarding the risks of pIV administration of 3% HTS may be overstated and unfounded.

What is 3% USP?

3% and 5% Sodium Chloride Injections USP are of particular value in severe salt depletion when rapid electrolyte restoration is of paramount importance. The low salt syndrome may occur in the presence of heart failure, renal impairment, during surgery, and postoperatively. In these conditions, chloride loss frequently exceeds sodium loss.

What is 3% sodium chloride injection?

3% and 5% Sodium Chloride Injections USP provide electrolytes and are a source of water for hydration. They are capable of inducing diuresis depending on the clinical condition of the patient.

What happens if you infuse sodium chloride?

Infusion of excess chloride ions may cause a loss of bicarbonate, resulting in an acidifying effect.

Why is a clinical evaluation and periodic laboratory determination necessary?

Clinical evaluation and periodic laboratory determinations are necessary to monitor changes in fluid balance, electrolyte concentrations, and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation.

How to protect pharmaceutical products from heat?

Exposure of pharmaceutical products to heat should be minimized. Avoid excessive heat. Protect from freezing. It is recommended that the product be stored at room temperature (25°C); however, brief exposure up to 40°C does not adversely affect the product.

What are the reactions that may occur because of the solution or the technique of administration?

Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation and hypervolemia.

Is sodium chloride safe for children?

Safety and effectiveness of sodium chloride injections in pediatric patients have not been established by adequate and well controlled trials, however, the use of electrolyte solutions in the pediatric population is referenced in the medical literature. The warnings, precautions and adverse reactions identified in the label copy should be observed in the pediatric population.

What happens if you inject 3% sodium chloride?

Depending on the volume and rate of infusion, the intravenous administration of 3% Sodium Chloride Injection can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration/hypervolemia, congested states, pulmonary edema, or acid-base imbalance. The risk of dilutive states is inversely proportional to the electrolyte concentration of the injection. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of the injection.

What is USP 3%?

3% Sodium Chloride Injection, USP is a sterile, nonpyrogenic, hypertonic solution for fluid and electrolyte replenishment in single dose containers for intravenous administration. The pH may have been adjusted with hydrochloric acid. It contains no antimicrobial agents. Composition, ionic concentration, osmolarity, and pH are shown in Table 1 .

What is 3% sodium chloride?

3% Sodium Chloride Injection is indicated as a source of water and electrolytes.

How to remove solution container?

Turn solution container over so that the text is face down. Using the pre-cut corner tabs, peel open the overwrap and remove solution container.

Why not connect flexible plastic containers in series?

Do not connect flexible plastic containers in series in order to avoid air embolism due to possible residual air contained in the primary container. Such use could result in air embolism due to residual air being drawn from the primary container before administration of the fluid from the secondary container is completed.

Why should plasma electrolytes be closely monitored in the pediatric population?

Plasma electrolyte concentrations should be closely monitored in the pediatric population as this population may have impaired ability to regulate fluids and electrolytes.

Is 3% sodium chloride hypertonic?

3% Sodium Chloride Injection is hypertonic with an osmolarity of 1,027 mOsmol/L. Administration of hypertonic solutions may cause venous damage and thus should be administered through a large vein, for rapid dilution.

How many children received 3% NaCl?

Two of the 9 studies identified in the review included only children. As shown in Table 1, a retrospective study reported by Brenkert et al 7 included 56 children (ranging in age from 0 to 18 years) who received 3% NaCl in an ED in the setting of traumatic brain injury, diabetic ketoacidosis, and hyponatremia with and without seizures. Infusion sites were determined for 53 of the 56 children; of these, 87% (n = 46) were in a peripheral site. None of the patients exhibited signs of phlebitis or local tissue injury. Missing from the report was criteria for detecting local infusion reactions. Size of the PIVC was not available in the majority of the children. A 2-month-old infant received an infusion of 3% NaCl via a 24-gauge catheter in the left hand reportedly without complication. The second pediatric study included in Table 1 was a retrospective report of 101 children (mean age of 5.9 years and mean weight of 27.6 kg), who received 3% NaCl during critical care transport as treatment for suspected cerebral edema, intracranial bleed with edema, or symptomatic hyponatremia. 8 A peripheral site was used for 97 of the 101 children; no infusion-related reactions were reported locally or systemically. However, criteria for detecting local infusion reactions were not described. The duration of the initial infusion ranged from 9 to 180 minutes (mean = 47 minutes). The bolus amount ranged from 14 to 600 mL of 3% NaCl (mean = 5.3 mL/kg). The investigators commented that the obvious significance of this finding is that use of a peripheral site during transport allowed for quick implementation of a potentially beneficial treatment.

What gauge is used to administer 3% NaCl?

As noted in Table 1, 16- and 18-gauge devices were often used to administer 3% NaCl in a peripheral vein. 2–4, 6 However, the rationale for this practice was not provided and is contrary to the practice criteria in the Standards. 11 Large-bore devices (eg, ≥18-gauge diameter) are typically recommended for the administration of viscous substances or for rapid infusion of fluids to treat hypovolemia. Hypertonic saline is not a viscous fluid, and the volumes used to treat hyponatremia do not require rapid administration.

Why is 3% NaCl used in a CVAD?

Until recently, many institutions restricted the infusion of 3% NaCl to a central vascular access device (CVAD) to avoid risk for phlebitis and tissue ischemia at a peripheral site. 1 However, in urgent situations, a growing number of studies have reported the administration of 3% NaCl with relative safety through a peripheral intravenous catheter (PIVC) when a CVAD is not already in place. 2–4 Because of this change in practice, nurses need to be familiar with guidelines for the safe administration of 3% NaCl in a peripheral site.

Why is it important to base practice on the most currently available evidence?

Basing practice on the most currently available evidence is critical to improving patient outcomes. Typically, hospital policies are formulated by an interdisciplinary committee based on literature reviews, as well as current guidelines from practice organizations. Since hospital policies may differ, nurses should review institutional policies before participating in the administration of 3% NaCl. Finally, additional well-designed studies with adequate sample sizes and consistent definitions of IRAEs are needed to better assess the risk of administering 3% NaCl through a peripheral vein.

When to administer 3% NaCl?

When a CVAD is already in place, 3% NaCl should be administered centrally . In the absence of a CVAD, multiple small studies provide support for using the peripheral route to infuse 3% NaCl when urgent treatment is needed to prevent neurologic complications. Settings in which peripheral infusions of 3% NaCl have been used include: EDs, ICUs, step-down units, general wards, critical care transport, and community sports events. If prolonged or repeated infusion of 3% NaCl is anticipated over days, placement of a CVAD should be considered. While the possibility of an IRAE is concerning, it is far less significant than the potential for neurologic complication due to delayed urgent therapy for severe hyponatremia. Frequent assessments for phlebitis and infiltration should be performed during the infusion, as well as frequent monitoring of the patient's neurologic status, serum sodium concentrations, and fluid status. Significant changes should be promptly reported to the treating physician.

What are the most important assessments during the administration of 3% NaCl?

Regardless of the infusion site (central or peripheral), the most important assessments during the administration of 3% NaCl are neurologic signs, serum sodium concentrations, and fluid status. A summary of factors to consider when monitoring for responses to the infusion of 3% sodium chloride is presented in Table 3.

What is the benefit of Bolus therapy?

Bolus therapy has the advantage of a more rapid controlled increase in serum sodium with less risk of overcorrection 24 and is currently the recommended therapy by consensus panels. 14 A potential complication from administering 3% NaCl is cerebral demyelination resulting from the overcorrection of hyponatremia.

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1.Administration of 3% Sodium Chloride Via a Peripheral …

Url:https://journals.lww.com/journalofinfusionnursing/Fulltext/2021/03000/Administration_of_3__Sodium_Chloride_Via_a.4.aspx

34 hours ago However, in the absence of a CVAD, several small studies suggest that 3% NaCl can be administered safely via a peripheral vein when urgent treatment is necessary. 2–4 Use of the …

2.Episode 368: Can 3% (hypertonic) sodium chloride be …

Url:https://www.pharmacyjoe.com/can-3-hypertonic-sodium-chloride-be-given-through-a-peripheral-iv/

36 hours ago  · Infusions of 3% sodium chloride are routinely recommended to be given through central, not peripheral IV lines. This recommendation is based on the theory that since the …

3.Administration of 3% Sodium Chloride Through …

Url:https://pubmed.ncbi.nlm.nih.gov/33783949/

33 hours ago A multidisciplinary team was established, and they developed an evidence-based protocol for the administration of 3% sodium chloride using peripheral intravenous catheters (PIVs), identified …

4.Safety of Continuous Peripheral Infusion of 3% Sodium …

Url:https://pubmed.ncbi.nlm.nih.gov/27965228/

15 hours ago The most common electrolyte abnormalities were hyperchloremia in 49.3% and hypokalemia in 46.9% of patients. Conclusion: Current recommendations that a central catheter is required for …

5.Sodium Chloride Injection 3% 5% - Drugs.com

Url:https://www.drugs.com/pro/sodium-chloride-injection-3-5.html

13 hours ago  · There is a common misconception that 3% NaCl cannot be administered through a peripheral vein. As such, many hospitals have policies restricting the use of 3% NaCl through a …

6.Peripheral 3% Hypertonic Saline is Safe - EMCrit Project

Url:https://emcrit.org/squirt/peripheral-hypertonic-saline-safe/

22 hours ago  · According to Infusion Nursing: An evidence- based approach 3rd edition -(Mary Alexander, Ann Corrigan, Lisa Gorski, Judy Hankins, Roxanne Perucca) the recommendation is …

7.3% Sodium Chloride Injection, USP - DailyMed

Url:https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=51da05ce-e3c4-4ef5-a845-dc869152e17f

19 hours ago  · Peripheral 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 …

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