3% NS

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Specializes in ICU.

Last night I had a patient with Na 125. The MD ordered 3% NS to go in at 30ml/h. I could not find a pump, so I used a dial-a-flo, not thinking anything about it. Well, when the next shift nurse came on, she about had a coronary stating that it HAD TO GO ON A PUMP.

I still can't find any reasons why, could someone please explain?

Thanks.

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Specializes in ICU/Critical Care.

I always thought that if you replace the sodium too fast, you could cause the patient to have a seizure. 3% NS should ALWAYS be on a pump.

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Specializes in Cardiac, ER.

Sodium must be replaced very slowly,...I'll try to look up some details,..but it is very very slowly.

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Specializes in ER.

Yes, 3% NS should always be on a pump. It's way too easy for a patient/family member to fiddle with the dial-a-flow and increase the flow. Some people fiddle with them just out of nervousness not realizing what it does.

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Specializes in ICU/Critical Care.

My book says that it can cause intravascular overload or hyperchloremic acidosis and pulmonary edema.. Must be infused slowly and with extreme caution which means you need a pump to monitor how many cc's you are giving.

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You should always run 3% NSS through a central line. That is the policy at my hospital.

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Specializes in Med Surg, ER, OR.

Try this thread...

https://allnurses.com/neuro-intensive-care/3-saline-202384.html

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Specializes in Psych, ER, Resp/Med, LTC, Education.

Curios as I have been in psych for a while now and out of straight med-- should this patient be on tele monitoring for the infusion--when I was inpatient psych we had to replace calcium via IV for a low Ca+ and before I hung it --I stopped and called the tele floor and low and behold-- the patient needed tele during the infusion --so we had to transfer the woman with a 1:1 for like half a day while that got taken care of...... the NP writing the order for me had no idea, nor did any of the nurses I was working with know this-- I was glad I listened to my gut and called tele to keep the patient safe-- So my question is...is tele monitoring needed with all replacement of electrolytes for a patient that is critically low enough to require IV replacement????? Including this 3% Na---never hung that one before....

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Specializes in ICU.

I am on a tele floor to begin with, so I really don't know. Obviously, since I am not smart enough to know it needed to be on a pump to begin with.

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For the most part, yes. If you are in a situation where you are giving 3% saline (hypertonic saline), you have a critical patient. In many cases, this concentration is used in patients who are severely hyponatremic with serious neurological signs and symptoms. Remember, the brain is very sensitive to sodium changes, while the heart is very sensitive to potassium changes. With severe hyponatremia, cerebral edema is a primary concern. Hypertonic saline is used to rapidly increase the sodium by around 4-5 Me q/L over the first couple of hours. We only correct enough to treat the serious neurological symptoms. Then, look at switching to another solution and slowly correct from there.

Obviously, we also want to correct the underlying cause of the hyponatremia. Another concept to consider is the fact that correcting sodium too fast can be met with devastating consequences. Osmotic demyelination syndrome being one of those devastating consequences. This is one medication that must be on a pump. The nurse was correct to be upset over only having a dial a flow up with this specific medication.

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A couple of years ago, I saw a list of the ten most dangerous drugs. Hypertonic saline was on the list.

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Specializes in Psych, ER, Resp/Med, LTC, Education.

okay...GilaRN, you sound like you know a lot about this stuff...not my area of expertise, but since mental health patients do have medical problems it's nice to try to stay somewhat knowledgable about medical stuff....so let me try to understand......the low Na+ levels effect more of the neuro/brain symptoms and not the heart? So tele isn't needed? correct? Is there any monitoring that should be done during the running? (obviously other then just keeping an eye on the patient)-- electronic monitoring I guess I am wondering about.....

I am curious as in psych we now and then see patients with signigicantly low Na+ levels related to water toxicity.....they will drink gallon after gallon and lower the level by diluting the blood with all the water..... I have had a patient or two with this and we limited water, locked the bathroom, and put the patient on sodium tablets....didn't end up with the need for IV but could I suppose so it would be nice to know how to handle it and know if the patient should go to medicine for treatment or if we could do it with the proper monitoring. .........

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