The Safety of Hypertonic Saline Administration Through Midline Catheters

IntroductionHypertonic saline (HTS) has been utilized in the treatment of several critical conditions including severe hyponatremia and elevated intracranial pressure. Current practice requires that HTS be administered through a central venous catheter (CVC). Midline catheters (MC) are a type of peripheral venous catheter (PIVC) placed in a large peripheral vein distal to the axillary vein. There are a few comprehensive studies investigating the efficacy of utilizing MCs for the administration of long-term HTS. MethodsA retrospective single center study performed at a tertiary care academic hospital, of patients admitted to the ICU for the administration of HTS through a MC. Data collected from 2019-2023 through a chart review of electronic medical records and recorded in REDCap.ResultsA total of 138 patients who received HTS via a MC were included in the analysis. Subjects were predominantly male (69.57%) and black (59.42%). The median age of the patient was 57 years ± 14.4 years old. The admission diagnoses included intracranial hemorrhage accounting for 67.39%, followed by altered mental status at 18.12%, trauma at 12.32% and sepsis at 7.25%.The concentrations of the HTS infusions were 2% NaCl in 54 patients, 3% NaCl in 82 patients, and 23% NaCl in 2 patients. The average duration of a continuous HTS infusion was 14 h and 34 min ± 15 h and 17 min. The average dosage rate was 86.03 ± 74.43 mL/h. Only one patient experienced thrombophlebitis. Thrombosis developed within the midline catheters for 5 patients. No complications related to drug extravasation or deep vein thrombosis were observed.ConclusionResults showed minor adverse events suggesting that MC may be a safe alternative for the administration of long-term HTS infusions. Midline catheters should be considered when weighing risk and benefits of HTS administration in the management of elevated intracranial pressure and severe hyponatremia.