Administering Hypertonic Saline to Patients With Severe Traumatic Brain Injury

Diane Schretzman Mortimer; Jon Jancik

Disclosures

J Neurosci Nurs. 2006;38(3):142-146. 

In This Article

Abstract and Introduction

Hypertonic saline (HTS) is an osmotic agent that can help patients in the acute phase of severe traumatic brain injury. HTS extracts fluid from swollen cerebral tissue to both control intracranial pressure and diminish the deleterious effects of secondary brain injury. Neuroscience nurses in intensive care and acute care units, who may administer HTS as resuscitation fluid, continuous infusion, or bolus dose, need to be familiar with physiologic actions, potential side effects, and appropriate HTS administration techniques. Neuroscience nurses collaborate with other members of the interdisciplinary team to ensure that HTS is administered safely.

Severe traumatic brain injury (TBI) is a major health problem in the United States. There are approximately 50,000 new cases per year, including 17,500 deaths (Narayan et al., 2002). Head injury, which causes significant mortality in all age groups (Bullock et al., 2000), is the leading cause of death in infants and children (Simma, Burger, Falk, Sacher, & Fanconi, 1998). TBI is a contributing factor in more than 60% of all trauma-related deaths (Bullock et al.).

The high mortality rate associated with severe TBI probably is in part due to the deleterious effects of secondary brain injury. The primary injury is often followed by secondary events hours and even days later (Bayir, Clark, & Kochanek, 2003). The occurrence of devastating secondary events accounts for the fact that inpatient mortality rates continue at an alarming 25%–33%, even at the best head injury centers in the country (Narayan et al., 2002). In fact, as many as 90% of patients who die from TBI show some evidence of secondary brain injury (Shackford et al., 1998).

Hypertonic saline (HTS) is an osmotic agent that may diminish the effects of secondary brain injury in patients with TBI. Given during the acute phase of head trauma care, this treatment is inexpensive and has manageable side effects. It has been determined to be safe and effective in multiple human trials. HTS can be given during resuscitation, via continuous infusion, or as a bolus dose (Doyle, Davis, & Hoyt, 2001). Nursing care for patients receiving HTS includes careful administration and close monitoring of laboratory values and patient status (Johnson & Criddle, 2004).

This article provides guidelines for HTS administration and a general plan for nursing care. The recommendations are based on protocols and results reported in previously published studies.

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