Administration of 3% Sodium Chloride Via a Peripheral Vein

Abstract

Three percent sodium chloride (3% NaCl) is a hyperosmolar agent that can be lifesaving for patients with severe hyponatremic encephalopathy, traumatic brain injury, and cerebral edema. Until recently, many institutions restricted the infusion of 3% NaCl to a central venous site to avoid infusion related adverse events (IRAEs) in peripheral veins. A growing number of studies have reported relatively safe administration of 3% NaCl through a peripheral vein. The incidences of IRAEs were evaluated in 9 studies that included 837 patients who received 3% NaCl through a peripheral vein. Infusion reactions were either uncommon or no more frequent than with routine solutions. The authors provide guidelines for the administration of and monitoring for complications associated with 3% NaCl through a peripheral vein, discuss the management of symptomatic hyponatremia, and provide illustrative cases.