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Can 3% normal saline be given peripherally and in a non ICU/ER setting?

Posted

Specializes in Medsurg/Tele. Has 2 years experience.

If a patient is critically hyponatremic and showing no nuero synmptoms, is this appropriate? In specific if the infusiin is going slow and not a bolus?

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 40 years experience.

3% is not "normal" saline.  You'd probably want to do your research on this.

LvlupNurse

Specializes in Medsurg/Tele. Has 2 years experience.

5 hours ago, TriciaJ said:

3% is not "normal" saline.  You'd probably want to do your research on this.

I meant 3% saline. My research yields nothing so far.

MountaineerFan57, BSN

Specializes in Critical Care/CVICU. Has 3 years experience.

Our policy is to only run it through a midline/central line and it requires a transfer to ICU. Regardless of how fast it’s infusing, you need frequent neuro checks and frequent lab draws/monitoring. 

IVRUS, BSN, RN

Specializes in Vascular Access. Has 32 years experience.

On 9/13/2020 at 12:46 PM, MountaineerFan57 said:

Our policy is to only run it through a midline/central line and it requires a transfer to ICU. Regardless of how fast it’s infusing, you need frequent neuro checks and frequent lab draws/monitoring. 

I would NEVER run a vesicant medication such as this via a MIDLINE.  That is a huge NO-NO.  Think about it:  Can you see, much less palpate the blood vessels under the shoulder or right before the Axillary vein?  NO... therefore, since the blood vessels are so deep , by the time you as a nurse notice s/s of issues, a huge issue is at hand.  Phlebitis, Extravasation, etc.... I would much rather see it infuse via short peripheral catheter (SPC) vs. a Midline.  But one would help the pt out immensely by ordering and getting a PICC or another CVAD in this pt.   

MountaineerFan57, BSN

Specializes in Critical Care/CVICU. Has 3 years experience.

11 hours ago, IVRUS said:

I would NEVER run a vesicant medication such as this via a MIDLINE.  That is a huge NO-NO.  Think about it:  Can you see, much less palpate the blood vessels under the shoulder or right before the Axillary vein?  NO... therefore, since the blood vessels are so deep , by the time you as a nurse notice s/s of issues, a huge issue is at hand.  Phlebitis, Extravasation, etc.... I would much rather see it infuse via short peripheral catheter (SPC) vs. a Midline.  But one would help the pt out immensely by ordering and getting a PICC or another CVAD in this pt.   

I don’t write the policies or write orders for invasive procedures 🤷🏼‍♀️ 

IVRUS, BSN, RN

Specializes in Vascular Access. Has 32 years experience.

On 11/6/2020 at 12:26 AM, MountaineerFan57 said:

I don’t write the policies or write orders for invasive procedures 🤷🏼‍♀️ 

I get that, you probably don't but I would seriously bring this up with your staff development person and DON

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Peripheral 3% Hypertonic Saline is Safe - EMCrit Project  Oct. 2016

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-

Multiple articles listed stating safe.

Complication Rates of 3% Hypertonic Saline Infusion Through Peripheral Intravenous Access

Journal of Neuroscience Nursing: June 2017 - Volume 49 - Issue 3 - p 191-195

Quote

...Results: There were 28 subjects across 34 peripheral lines monitored. Overall, subjects received 3% HTS for a duration between 1 and 124 hours with infusion rates of 30 to 50 mL/h. The rate of complications observed was 10.7% among all subjects. Documented complications included infiltration (n = 2), with an incidence of 6%, and thrombophlebitis (n = 1), with an incidence of 3%.

Conclusions: There has been a long concern among healthcare providers, including nursing staff, in regard to pIV administration of prolonged 3% HTS infusion therapy. Our study indicates that peripheral administration of 3% HTS carries a low risk of minor, nonlimb, or life-threatening complications. 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.

 

 

IVRUS, BSN, RN

Specializes in Vascular Access. Has 32 years experience.

First of all Karen, this conclusion, imo, is nonsensical.  Yes, having a central line in increases the chance of large vessel thrombosis, but the benefit of having it is so much better than the inherent risk.   Bloodstream infections can occur with all types of IV catheters especially if ANTT is not followed.  Pneumothorax is a concern only upon catheter placement, and arterial injury??? I've seen unskilled MD's attempt vascular line placement and go intra-arterial instead of in the vein, but again, those are unskilled physicians. 

Also, greater than 1 out of 10 had issues... that is unacceptable. 

And, it says the risk may be overstated and unfounded.  The osmolarity of 3% Sodium Chloride is > 1,000.  Anything over 900, has a much greater probability of causing serious harm to the smaller blood vessels in the arms.  Circulation/blood flow is nowhere near what it is in the central venous system.  Disagree with this "study".   

However, as said in my earlier post, I would much rather see this infused via SPC, than a Midline, and that was really what my comment was about.