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 G. Geocadin, Pouya Tahsili-Fahadan, Laith R. Altaweel

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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)
Pages (from-to)364-371
Number of pages8
JournalNeurocritical care
Issue number2
StatePublished - Apr 15 2019


  • 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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