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

The Role of HTS in the Subacute Phase of Head-Injury Care

Questions about how long to continue HTS therapy have not been definitively resolved. Most studies of HTS have only examined its effects during the acute phase of head trauma care. During the subacute phase, however, patients may still require HTS. The treatment goal is to combat downward-trending serum sodium levels and to prevent associated episodes of cerebral edema (Horn, et al., 1999).

The subacute phase of treatment lasts for approximately 7–10 days after the last ICP spike during the acute phase. Serum sodium levels should be maintained in the high-normal range, around 145–150 mmol/L, during this time. Actions aimed at maintaining serum sodium levels need to be individualized based on the patient's electrolyte levels, fluid status, and recovery stage (Qureshi et al., 1998).

Interventions geared toward preventing decreases in serum sodium levels can include administering salt tablets and implementing an appropriate fluid restriction. If necessary, the HTS infusion can be continued. Patients without central lines who require continuous HTS therapy can receive 2% NaCl via a peripheral line (Qureshi et al., 1998).

Lab reports can be checked less frequently than during the acute phase because they are not as dynamic in the subacute phase. If patients are not receiving HTS, serum sodium levels should be checked daily. If patients are receiving HTS, levels should be checked at least every 12 hr (Qureshi et al., 1998).

During the subacute phase, when patients may no longer be in critical care units, communication and collaboration are especially important. Nurses need to educate patients, family members, and other staff members about the plan of care. Nurses need to collaborate with other team members, including rehabilitation staff, to ensure that appropriate monitoring of sodium therapy continues until hyponatremia and its associated complications are no longer likely to occur (Wright, 1999).

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