Guidelines for Administering 3% NaCl Infusions Via Peripheral Intravenous Catheters (PIVCs)

UPMC Children's Hospital of Pittsburgh Division of Pediatric Nephrology clinical director Michael L. Moritz, MD, FASN, co-authored a new review paper on the administration of 3% sodium chloride infusions via a peripheral intravenous catheter (PIVC) in emergent conditions. The paper was published in February in the Journal of Infusion Nursing with co-author Norma A. Metheny, PhD, RN, FAAN, from the Trudy Busch Valentine School of Nursing at Saint Louis University.

There is a common misconception that 3% NaCl cannot be administered through a peripheral vein. As such, many hospitals have policies restricting the use of 3% NaCl through a central line to avoid or limit the incidence of adverse infusion events. However, there is no evidence to support this concern, and a growing body of evidence demonstrates that it is safe to administer 3% NaCl via PIVC.

Drs. Moritz and Metheny conducted a systematic review of nine studies in the literature comprising a total of 837 cases of 3% NaCl infusion via PIVC, which demonstrated no increased risk of infusion reactions. This is an important finding as placement of a central line can delay potentially life-saving therapy in emergent situations, in addition to the fact that CAVDs are associated with patient discomfort and thrombotic and infectious complications. 

The paper discusses the management of symptomatic hyponatremia with the administration of PIVC 3% NaCl, and the authors provide a series of four brief case studies illustrating clinical care scenarios involving 3% NaCl infusions. Drs. Moritz and Metheny also review the current indications, recommendations, and guidelines for using 3% NaCl through a PIVC.

Of note, monitoring the neurologic status in patients with symptomatic hyponatremia is critical with the use of 3% NaCl, as is monitoring serum sodium concentrations and fluid balance.

"Administering 3% NaCl through a central line is the preferred approach, but it is not always possible, particularly in emergent conditions where there is symptomatic hyponatremia or increased intracranial pressure. Our review found prospective and retrospective studies in children and adults that were supportive of safety and efficacy of peripheral administration. Clinicians and hospitals need to examine and keep current with their policies and practices for the use of 3% NaCl administered through a peripheral vein when circumstances arise indicative of its use,” says Dr. Moritz.

More About Dr. Moritz

Michael L. Moritz, MD, FASN, is professor of pediatrics in the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine. Dr. Moritz is the Division’s clinical director, as well as the medical director of the Kidney Transplant Program and medical director of pediatric dialysis at UPMC Children’s. Dr. Moritz is a leading researcher and expert in the fields of sodium disorders and water metabolism. 

Reference

1. Metheny NA, Moritz ML. Administration of 3% Sodium Chloride Via A Peripheral Vein. J Infusion Nursing. 2021. DOI 10.1097/NAN.0000000000000420.