Administration of 3% Sodium Chloride via Peripheral IV

Indications and Contraindications

The American Society of Anesthesiologists indicates that 3% hypertonic saline is used for symptomatic hyponatremia and hyponatremic encephalopathy, increased intracranial pressure in traumatic brain injury with focal neurological signs, and severe head trauma with focal neurological signs due to its osmotic effect 1, 2, 3
The guideline society recommends against using 3% hypertonic saline as first-line fluid therapy for volume resuscitation in hemorrhagic shock (GRADE 1- strong recommendation), as meta-analyses involving 2,932 patients showed no mortality benefit when hypertonic saline was used for resuscitation compared to isotonic solutions 1, 2, 4

The guideline society suggests that 3% sodium chloride can be safely administered through a peripheral intravenous cannula, with a low rate of complications, and recommends a maximum infusion rate of 50 mL/hour for peripheral administration 1, 2
The American College of Surgeons recommends against exceeding 50 mL/hour infusion rate through peripheral access without close monitoring, and against using 3% NaCl for volume resuscitation in hemorrhagic shock without severe head trauma—use balanced crystalloids instead 1, 5