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Intraosseous Administration of 23.4% NaCl for Treatment of Intracranial Hypertension

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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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Acknowledgement

The authors gratefully acknowledge the clinical support from all the nursing staff at the Emergency Department and Neuroscience Intensive Care Unit of Inova Fairfax hospital, as well as Ann K Aizon and Tricia Brannon, Clinical Research Coordinators from Department of Research, Inova Neurosciences, for their unconditional support.

Funding

This study was not funded.

Author information

Authors and Affiliations

  1. Neuroscience Intensive Care Unit, Medical Critical Care Service, Department of Medicine, INOVA Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA, 22042, USA

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

  2. Neurocritical Care Unit Division, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA

    Romergryko G. Geocadin & Pouya Tahsili-Fahadan

  3. Neuroscience Research, Neuroscience and Spine Institute, INOVA Fairfax Hospital, Falls Church, VA, USA

    Laith R. Altaweel

Authors
  1. Jing Wang
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  2. Yun Fang
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  3. Subhashini Ramesh
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  4. Asma Zakaria
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  5. Maryann T. Putman
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  7. James Paik
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  8. Romergryko G. Geocadin
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  9. Pouya Tahsili-Fahadan
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Contributions

JW and LA were involved in study concept and design. All authors contributed to acquisition, analysis, and interpretation of data. YF and JP contributed to statistical analysis. JW, LA, and PT-F were involved in drafting of the manuscript

Corresponding author

Correspondence to Laith R. Altaweel.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Additional information

Pouya Tahsili-Fahadan and Laith R. Altaweel co-senior authors.

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Wang, J., Fang, Y., Ramesh, S. et al. Intraosseous Administration of 23.4% NaCl for Treatment of Intracranial Hypertension. Neurocrit Care 30, 364–371 (2019). https://doi.org/10.1007/s12028-018-0637-2

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  • DOI: https://doi.org/10.1007/s12028-018-0637-2

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