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Safety of Continuous Peripheral Infusion of 3% Sodium Chloride Solution in Neurocritical Care Patients

Background Numerous drug information resources recommend that continuous intravenous 3% sodium chloride solution be administered via a central catheter. Objectives To evaluate the incidence of infusion‐related reactions and electrolyte abnormalities in neurocritical care patients treated with continuous intravenous infusion of 3% sodium chloride solution via a peripheral catheter. Methods Data on patients treated with continuous intravenous infusion of 3% sodium chloride solution at 2 academic medical centers were evaluated retrospectively to determine the administration site. Electronic notes on catheter status were reviewed to determine the occurrence of infusion‐related reactions. Prespecified thresholds were used to assess electrolyte abnormalities. Results Of 213 patients who had peripheral continuous intravenous infusions of 3% sodium chloride solution, 15 (7%) had infusion‐related reactions. Administration was changed to a central catheter in 56 patients (26.3%), but only 5 changes were due to an infusion‐related reaction. Most (157 patients, 73.7%) received their entire treatment peripherally, for a median duration of 44 hours, 3 minutes. The most common electrolyte abnormalities were hyperchloremia in 49.3% and hypokalemia in 46.9% of patients. Conclusion Current recommendations that a central catheter is required for continuous intravenous infusion of 3% sodium chloride solution should be reevaluated. Only a few patients who had peripheral infusions had infusion‐related reactions. Electrolyte abnormalities occurred frequently with peripheral infusion, but the clinical importance of the abnormalities remains unclear.