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gaelyn lovejoy
3% Saline Administration via peripheral access.
All the standards that the Phazrmacist and I can find say that it should be given centrally.  Yet there is no clear research I can find that specficially states the complications and why directly.  Does anyone have any data or literature that supports central line usage?
rivka livni
Any infusant the have an

Any infusant the have an Osmolality 550-600 or greater should NOT be given peripherally because it causes severe damage to the vein's intima.

gaelyn lovejoy
I have found the same
I have found the same information.  But there is no informatiion on what research thiis based on.  Do you have any references?  Thanks
lynncrni
There is animal research on
There is animal research on the extend of vein damage from extremes of pH and osmolarity. This is extrapolated to humans and used to establish the standards. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

rivka livni
I am sorry to say that not
I am sorry to say that not everything has to be research based. Just as you do not need research to find out that if you put your hand on a flame it will burn the skin and cause skin damage, if you know what the blood osmolarity is, and how the epithilial cell along the intima functions, you should know what will happen to that cell if you infuse a hyperosmolar or hyposmolar fluid into that blood. It is common sense. 
gaelyn lovejoy
I understand that everything

I understand that everything is not based on research that we do.  In nursing related to Vascular Access we have little valid recent research to back our practices in some areas.  In my practice all changes have to be evidience based.  If what we see in our practice is a know issuse and I don't have evidence to support the change  it is not a easy fight.  We all know 3% saline is to be administered centrally and when you are discussing this issue with doctors I need hard facts.  Educational materials, product IFU's and reference books are not winning our fight when no one can site the research that the practice was based on.

Thanks for your input. 

lynncrni
Here is the research that I

Here is the research that I am aware of:

1.    Kuwahara T, Asanami S, Kawauchi Y, Kubo S. Experimental infusion phlebitis: Tolerance pH of peripheral veins. Journal of Toxicology Science. 1999;24(2):113-121.
2.    Kuwahara T, Asanami S, Kubo S. Experimental infusion phlebitis: Tolerance osmolality of peripheral venous endothelial cells. Nutrition. 1998;14(6):496-501.
3.    Kuwahara T, Asanami S, Tamura T, Kubo S. Dilution is effective in reducing infusion phlebitis in peripheral parenteral nutrition: An experimental study in rabbits. Nutrition. 1998;14(2):186-190.
This is animal research that can be extrapolated to humans. For ethical reasons, we may never get human research on this and many other issues. So to ignore the facts brought out in these studies because there is no recent human studies is putting your patients at unnecessary risk. This risk will show up in the form of lawsuits when patients experience a severe outcome from thrombosis, extravasation or some other complication. Please keep working to change your practices. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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