Intraosseous Administration of 23.4% NaCl for Treatment of Intracranial Hypertension

Jing Wang, Yun Fang, Subhashini Ramesh, Asma Zakaria, Maryann T. Putman, Dan Dinescu, James Paik, Romergryko Geocadin, Pouya Tahsili-Fahadan, Laith R. Altaweel

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalNeurocritical Care
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Brain herniation
  • Central venous catheter
  • Hypertonic saline
  • Intracranial hypertension
  • Intraosseous cannulation

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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    Wang, J., Fang, Y., Ramesh, S., Zakaria, A., Putman, M. T., Dinescu, D., Paik, J., Geocadin, R., Tahsili-Fahadan, P., & Altaweel, L. R. (Accepted/In press). Intraosseous Administration of 23.4% NaCl for Treatment of Intracranial Hypertension. Neurocritical Care. https://doi.org/10.1007/s12028-018-0637-2