3% NaCl Infusions Via Peripheral Line to Treat Hyponatremia – New UPMC Study Finds No Evidence of Local Infusion Reactions in 10 Years of Data

3% sodium chloride (3% NaCl) infusion is an effective therapy in cases of symptomatic and nonsymptomatic hyponatremia, including emergent cases of hyponatremic encephalopathy and other situation in which intracranial pressures are dangerously high.

There is a common misconception that 3% NaCl cannot be administered through a peripheral vein. As such, many hospitals and hospital pharmacies have policies restricting the use of 3% NaCl to a central line to avoid or limit the incidence of adverse infusion events. However, there is little evidence to support this concern, and a growing body of evidence demonstrates that it is safe to administer 3% NaCl via a peripheral vein, particularly in emergent situations whereby waiting for implementation of a central venous catheter may prove injurious or negatively affect the patient’s outcome.

A new study from UPMC published in August 2022 analyzed 10 years of patient data across the entire health care system to ascertain the incidence and nature of adverse local infusion events as a result of 3% NaCl administration through a peripheral vein.

Leading the study was Michael L. Moritz, MD, clinical director and director of dialysis in the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh. Joining Dr. Moritz in the study was Joel B. Nelson, MD, chair of the Department of Urology at UPMC and the University of Pittsburgh School of Medicine, and Juan C. Ayus, MD, from the University of California Irvine.

Dr. Moritz and colleagues examined system data from 2010 to 2020 across all UPMC hospitals, which as of 2020 included 40 facilities encompassing 8,400 patient beds. The study first accounted for the total number of nonchemotherapy and noncontrast IV extravasation events across the system (23,714, of which 4,678 occurred at UPMC Children’s).

Next, the researchers identified the total number of patients who received 3% NaCl infusions across the entire system, either through a peripheral or central line, and found a total of 2,306, 826 of which were in pediatric patients treated at UPMC Children’s. The remaining 1,480 patients were adults treated at any UPMC hospital during the study period.

Dr. Moritz and colleagues then examined the 3% NaCl cases, cross referencing the data against all the nearly 24,000 reported IV events during the 10-year analysis period.

“Our analysis found no reports of adverse IV events in the administration of 3% NaCl in any of patient, child or adult,” says Dr. Moritz. “These findings from our large system, across dozens of hospitals and over 10 years, provides significant support to the safety of administering 3% NaCl via peripheral vein when needed.”

Learn more about the study and its findings using the link below to the full paper which may be read or downloaded in its entirety from the PubMed catalog.

Reference

Moritz ML, Ayus JC Nelson JB. Administration of 3% Sodium Chloride and Local Infusion Reaction. Children (Basel). 2022 Aug 18; 9(8): 1245.

Further Reading

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