The Safety of Hypertonic Saline Administration Through Midline Catheters

Authors

• Suhali Kundu, Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Seda Akben, Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Jeffrey Shipley, Emergency Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
• Sasa Ivanovic, Yale New Haven Hospital, New Haven, CT, USA.
• Katrina Hawkins, Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Daniel King, Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Danielle Davison, Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• David Yamane, Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Document Type

Journal Article

Publication Date

3-23-2026

Journal

Journal of intensive care medicine

DOI

10.1177/08850666261432139

Keywords

ICU outcomes; brain injury; central venous catheters; hypertonic saline; intensive care; intracranial pressure; midlines catheters; neuro-ICU

Abstract

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.

APA Citation

Kundu, Suhali; Akben, Seda; Shipley, Jeffrey; Ivanovic, Sasa; Hawkins, Katrina; King, Daniel; Davison, Danielle; and Yamane, David, "The Safety of Hypertonic Saline Administration Through Midline Catheters" (2026). GW Authored Works. Paper 8846.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8846

Department

Anesthesiology and Critical Care Medicine