From the Research
The maximum flow rate for intravenous administration of normal saline (0.9% sodium chloride solution) should not exceed 999 mL/hour through a peripheral IV line for adults without cardiac or renal concerns, with more common rates being 150-250 mL/hour for maintenance fluids, as supported by the most recent and highest quality study available 1.
Key Considerations
- The clinical situation and patient factors play a crucial role in determining the maximum flow rate for normal saline administration.
- For emergency situations requiring rapid volume resuscitation, boluses of 500-1000 mL can be administered over 15-30 minutes, equivalent to 1000-4000 mL/hour, using pressure bags or rapid infusers.
- Pediatric patients require a maximum rate calculated based on weight, typically not exceeding 20-40 mL/kg/hour for maintenance.
- Elderly patients and those with cardiac or renal dysfunction require more conservative rates, often 50-125 mL/hour, with close monitoring.
Evidence-Based Recommendations
- The selection and use of resuscitation fluids may affect patient outcomes, but the optimal resuscitative fluid remains controversial, as shown in a systematic review and meta-analysis comparing balanced crystalloids and normal saline in ICU patients 1.
- Balanced crystalloids may not improve outcomes of mortality, incidence of acute kidney injury, and use of renal replacement therapy for critically ill patients compared to normal saline, but may reduce the risk of death in patients with non-traumatic brain injury.
- Regular assessment of vital signs, urine output, and clinical status is essential when administering intravenous fluids at higher rates to prevent fluid overload, pulmonary edema, or electrolyte imbalances.
Clinical Implications
- The maximum safe rate for normal saline administration must be individualized based on the patient's condition.
- Clinicians should be aware of the potential risks and benefits associated with different resuscitation fluids and tailor their approach to the specific needs of each patient.
- Further research is needed to determine the optimal resuscitative fluid for specific patient populations, as highlighted by the most recent study available 1.