Intraosseous access to administer 23.4% NaCl in the emergency setting

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Intraosseous catheterization is an alternative route of venous access that may result in more rapid administration of 23.4% NaCl” Wang et al (2018).

Abstract:

BACKGROUND/OBJECTIVE: Prompt treatment of acute intracranial hypertension is vital to preserving neurological function and frequently includes administration of 23.4% NaCl. However, 23.4% NaCl administration requires central venous catheterization that can delay treatment. Intraosseous catheterization is an alternative route of venous access that may result in more rapid administration of 23.4% NaCl.

METHODS: Single-center retrospective analysis of 76 consecutive patients, between January 2015 and January 2018, with clinical signs of intracranial hypertension received 23.4% NaCl through either central venous catheter or intraosseous access.

RESULTS: Intraosseous cannulation was successful on the first attempt in 97% of patients. No immediate untoward effects were seen with intraosseous cannulation. Time to treatment with 23.4% NaCl was significantly shorter in patients with intraosseous access compared to central venous catheter (p < 0.0001). CONCLUSIONS: Intraosseous cannulation resulted in more rapid administration of 23.4% NaCl with no immediate serious complications. Further investigations to identify the clinical benefits and safety of hypertonic medication administration via intraosseous cannulation are warranted.

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Reference:

Wang, J., Fang, Y., Ramesh, S., Zakaria, A., Putman, M.T., Dinescu, D., Paik, J., Geocadin, R.G., Tahsili-Fahadan, P. and Altaweel, L.R. (2018) Intraosseous Administration of 23.4% NaCl for Treatment of Intracranial Hypertension. November 5th. .

doi: 10.1007/s12028-018-0637-2.

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