Safety of Peripherally Administered 23.4% Sodium Chloride.

IF 3.6 3区 医学 Q2 CLINICAL NEUROLOGY
Christian R Silva, Jessica Nagy, Andrew R Zullo, Rebecca A Greene
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Abstract

Background: 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 a level I trauma center or one 247-bed academic community hospital. Study participants 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 died within 24 h of 23.4% sodium chloride administration or were discharged less than 24 h after administration were excluded. All study participants received at least one 30 mL bolus of 23.4% sodium chloride administered through a peripheral IV catheter.

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 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 who did experience a possible or probable extravasation event. Diabetes mellitus was a possible risk factor for extravasation.

23.4%氯化钠外周注射的安全性。
背景:对于颅内压升高的患者,及时开始23.4%氯化钠高渗治疗可最大限度地减少永久性神经损伤并预防脑疝。放置中心静脉导管可以延迟渗透治疗的时间,并可能对患者的预后产生负面影响。本研究的目的是检查23.4%氯化钠通过外周静脉(IV)导管给药的安全性。方法:这是一项在大型学术卫生系统进行的回顾性观察队列研究。患者被送往一个拥有719个床位的学术医疗中心和一个一级创伤中心或一个拥有247个床位的学术社区医院。研究参与者年龄在18岁及以上,于2015年3月29日至2023年10月21日期间入院,并通过外周静脉注射接受23.4%氯化钠治疗。排除23.4%氯化钠治疗后24小时内死亡或服药后24小时内出院的患者。所有研究参与者通过外周静脉导管至少接受一次30毫升23.4%氯化钠注射。结果:主要结局定义为外周给药23.4%氯化钠外渗,采用Naranjo药物不良反应概率量表评估,863次给药中有56次(6.4%)发生。次要结局包括组织坏死的发生率、用于治疗外渗的干预措施和外渗的归因危险因素。没有组织坏死病例,没有进行手术干预,有一例使用透明质酸酶进行医疗干预。有糖尿病史的患者发生23.4%氯化钠外渗事件的风险高出2.39倍(95% CI 1.41-4.05, p = 0.001)。结论:外周给药23.4%氯化钠与可能发生外渗事件的患者的低外渗率相关,并且没有明显的损伤。糖尿病是外渗的可能危险因素。
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来源期刊
Neurocritical Care
Neurocritical Care 医学-临床神经学
CiteScore
7.40
自引率
8.60%
发文量
221
审稿时长
4-8 weeks
期刊介绍: Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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