23% Saline IV Bolus

[fiveofpeep]

Do you guys/gals give hypertonic (and I dont mean 3%--I mean 23%) saline for increased ICP in your neuro ICU? What have you experienced with it?

I've seen it work with no ill effects being pushed quite fast.

Recently in a patient who had it administered 3 times in a 24hr period, I saw severe hypotension that coincided with the IV administration--requiring the drips to be maxed until about 5 mins after being given. I also saw severe ectopy and hypokalemia (although the patient wasnt diuresing all that much and had already had K replaced that day.)

This patient was about to code from the 23% and the docs still wanted to give it. It also only marginally decreased the ICP. There isnt alot of literature about it on the internet or micromedix either so I only know what I have experienced up to this point.

Any thoughts?

[GrnHonu99, RN]

we give it but only after mannitol and maintaining a tight Na parameter. You MUST MUST MUST check serum osmos and Na before giving it!!!! wE dont usually give it back to back we have to wait like 6 hours or so.

[futbol84]

Sorry no experience with 23% saline but we do bolus 3% hypertonic saline and it seems to work pretty well. Again as GrnHonu99 said check your sodiums and serum osmos. Each hospital runs them a little different but I've seen some patients get a ton of mannitol and 3% until we can do a crani

[jellybeanmead]

Yes, we give it. You check NA every 4 hours. It seems to work well, but, it always depends on the patient and the brain!!

[GrnHonu99, RN]

have found in some places you can only admin through central line..we give it PIVs..4-5 years ago we would push it (slow) but now we just piggyback it..

[experienceawareness]

Pt's can go into asystole if pushed too fast and in someone who will do this you can actually watch their ECG changes as you push, which just tells you to push it slower.

[fiveofpeep]

thanks guys :)

[nrsang97, BSN, RN]

We do use them as an IVP given by the intensivest in an emergency along with mannitol. We aslo give IVPB every 6-8 hours based on NA paramaters written. Only through a central line. We do give 3% boluses too.