From the FDA Drug Label
Sodium Chloride Injection, USP, 23. 4% is hypertonic and must be diluted prior to administration. The answer is no, hypertonic saline is not required for central line administration, but rather it must be diluted prior to administration, regardless of the administration route. 1
From the Research
Hypertonic saline does not require central line administration, as peripheral administration of 3% hypertonic saline has been shown to be safe and effective with minimal complications. This is based on the most recent and highest quality study available, which found that peripheral administration of 3% hypertonic saline had a low rate of complications, including infiltration, phlebitis, erythema, edema, and venous thrombosis 2. The study, published in 2023, analyzed data from 10 studies and found that the overall incidence of complications was low, with the highest incidence being phlebitis at 6.2% (95% C.I. = 1.1-14.3%) 2.
Key Findings
- Peripheral administration of 3% hypertonic saline is considered a safe and possibly preferred option due to its low risk of complications and less invasive procedure compared to central venous catheter (CVC) placement 2.
- The risk of complications, such as phlebitis, erythema, edema, and venous thrombosis, is minimal and can be mitigated with careful monitoring and proper catheter placement 2, 3.
- Higher concentrations of hypertonic saline (>3%) may still require central line administration due to the increased risk of complications, but this is not supported by the most recent evidence 2.
Clinical Implications
- In emergency situations where central access is not immediately available, peripheral administration of 3% hypertonic saline may be a viable option with careful monitoring 2, 3.
- The decision to use peripheral or central administration of hypertonic saline should be based on individual patient needs and clinical judgment, taking into account the potential risks and benefits of each approach 2, 3.