From the Guidelines
Hypertonic saline should be administered through a central venous line rather than a peripheral line whenever possible, especially for concentrations greater than 3%. If peripheral administration is absolutely necessary due to emergency situations, 3% hypertonic saline can be given peripherally at a maximum rate of 0.5-1 mL/kg/hour, not exceeding 50-100 mL/hour in adults, as higher rates may increase the risk of complications such as phlebitis and tissue damage 1. The infusion site should be monitored closely for signs of infiltration or phlebitis. Higher concentrations (>3%) should never be administered peripherally due to the high risk of tissue damage, pain, and vascular injury. Key considerations for administration include:
- Monitoring the infusion site closely for signs of complications
- Avoiding concentrations greater than 3% in peripheral lines
- Considering central line placement for ongoing therapy or higher concentration needs
- Being aware of the potential for hypertonic saline to cause significant osmotic shifts and damage peripheral veins due to its high osmolarity, as noted in the use of varying concentrations and osmolar loads 1. In clinical practice, the safety and efficacy of hypertonic saline administration are crucial, and adherence to guidelines and careful patient monitoring can help minimize risks and optimize outcomes.
From the Research
Administration Rates of Hypertonic Saline
- The administration rate of hypertonic saline through a peripheral intravenous (IV) line can vary, with some studies suggesting rates up to 50 mL/h 2 and others indicating rates as high as 75 mL/h 3.
- A study published in 2023 found that rapid, peripheral administration of 3% hypertonic saline boluses at rates up to 999 mL/h did not result in extravasation or phlebitis 3.
- Another study from 2021 noted that infusion-related adverse events were minimal when 3% hypertonic saline was administered through a peripheral intravenous catheter at a high infusion rate (83.3 mL/h) and for a prolonged duration (≥ 6 hours) 4.
- The overall incidence of complications associated with peripheral administration of 3% hypertonic saline was found to be low, with rates of infiltration, phlebitis, erythema, edema, and venous thrombosis ranging from 1% to 6.2% 5.
Factors Influencing Administration Rates
- The gauge of the peripheral IV catheter may influence the administration rate, with larger gauge catheters potentially allowing for faster infusion rates 2.
- The location of the peripheral IV catheter, such as the antecubital fossa, may also impact the administration rate and risk of complications 3.
- The duration of administration and the total dose of hypertonic saline may also contribute to the risk of infusion-related adverse events 4.