Critical Care Medicine | 2019
767: SAFETY OF PERIPHERAL LINE ADMINISTRATION OF 3% HYPERTONIC SALINE AND MANNITOL IN THE ED
Abstract
Learning Objectives: Hypertonic saline (HTS) and mannitol are frequently used in the Emergency Department (ED) to manage elevations in intracranial pressure (ICP). Due to concern for extravasation leading to tissue injury, some literature recommends administering HTS via central intravenous (IV) line. Mannitol, another hyperosmolar agent, is not associated with this concern. The objective of this study was to compare the incidence of extravasation when 3% HTS or mannitol were administered via peripheral IV (PIV). Methods: This retrospective, single center, cohort study evaluated patients given 3% HTS or mannitol (20 or 25%) via PIV while in the ED. Patients treated between 4/2013 and 9/2015 were included. Patients were excluded if pregnant, given mannitol for dialysis, or if they received both agents concurrently. The primary outcome was extravasation incidence. Secondary outcomes included: severity of extravasation injury, electrolyte abnormalities, incidence of acute kidney injury (AKI), ICP 24 hours post admission, duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), in-hospital mortality, and discharge Glasgow Coma Score (GCS). Data are reported as N(%), mean(SD), or median(IQR). A power calculation determined 200 patients would be needed. Results: 192 patients were included in this study. 49 (26%) were pediatric. 85 (44%) received HTS and 107 (56%) received mannitol. Patients receiving HTS were younger (27.5 ± 24.3 vs. 53.9 ± 22.3 years;p<0.001)). HTS was more often used for traumatic brain injury (55.3% vs. 39.3%;p<0.001) and mannitol was more often used for intracerebral hemorrhage (44.9% vs. 21.25%;p=0.015). There was no incidence of extravasation in either group. Patients who received HTS had lower ICP 24 hours post admission (2.107 ± 5.5 vs. 4.236 ± 8.1 mmHg;p=0.047) and had a higher GCS at discharge (14(IQR 3–15) vs. 3(IQR 3–14.2);p=0.00386). In-hospital mortality was higher in the mannitol group (54.7% vs. 32.9%;p=0.003). Duration of MV was shorter in those patients who received HTS (1 day(IQR 0–56) vs. 2 days(IQR 0–56);p=0.023). There were no differences in incidence of electrolyte abnormalities, AKI, or LOS. Conclusions: There were no incidences of extravasation among patients given 3% HTS or mannitol via PIV. Patients that received HTS had lower hospital mortality, ICP 24 hours post admission, shorter duration of mechanical ventilation, and higher discharge GCS. Clinicians should reconsider recommendations to restrict 3% HTS to central lines.