Safety of peripherally administered 23.4% sodium chloride

Background/Objective For patients with increased intracranial pressure, prompt initiation of hyperosmolar therapy with 23.4% sodium chloride may minimize permanent neurological damage and prevent cerebral herniation. Placement of a central venous catheter can delay time to osmotherapy and may negatively impact patient outcomes. The objective of this study was to examine the safety of 23.4% sodium chloride administered through a peripheral intravenous (IV) catheter. Methods This was a retrospective observational cohort study conducted at a large academic health system. Patients were admitted to one 719-bed academic medical center and level 1 trauma center or one 247-bed academic community hospital. Subjects were 18 years or older, admitted between March 29, 2015 and October 21, 2023, and received 23.4% sodium chloride through a peripheral IV. Patients who expired or were discharged less than 24 hours after hypertonic saline administration were excluded. All subjects received at least one 30 milliliter bolus of 23.4% sodium chloride administered through a peripheral IV catheter. Measurements and Main Results The primary outcome, defined as extravasation of peripherally administered 23.4% sodium chloride, was assessed using the Naranjo Adverse Drug Reaction Probability Scale and occurred in 56 out of 863 administrations (6.4%). Secondary outcomes included incidence of tissue necrosis, interventions used to treat extravasations, and attributable risk factors for extravasation. There were no cases of tissue necrosis, no surgical interventions performed, and one case of medical intervention using hyaluronidase. Patients with a history of diabetes had a 2.39 times higher risk of experiencing a 23.4% sodium chloride extravasation event (95% CI 1.41–4.05 [p = 0.001]). Conclusions Peripheral administration of 23.4% sodium chloride was associated with a low rate of extravasation and no significant injury in patients that did experience a possible or probable extravasation event. Diabetes mellitus was a possible risk factor for extravasation.