Normal Saline Solution

 


Other Names

•  0.9% Sodium Chloride Solution


Classification

  1.   Isotonic volume expander

  2.   Electrolyte replacement


Action

  1. Normal Saline is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment.

  2. It contains no antimicrobial agents.

  3. The pH is 5.0 (4.5 to 7.0).

  4. It contains 9 g/L Sodium Chloride with an osmolarity of 308 mOsmol/L.

  5. It contains 154 mEq/L Sodium and Chloride.


Indications

  1. It is indicated as a source of water and electrolytes.

  2. In general, intravenous lines should not be started unless the patient currently, or may soon need either fluid replenishment or medication administration. 

  3. If used to replenish fluids, a large bore IV (18G or more) should be started, hung with a 1000 mL bag of saline. 

  4. If saline is being started for medication administration maintain at TKVO, or consider using a saline lock instead of intravenous line.

Contraindications

  1. Severe Hypertension

  2. Pulmonary edema


Precautions

  1. If administering a fluid bolus check BP and lung sounds every 250cc.  Discontinue bolus if pulmonary edema is discovered, or once BP is in therapeutic range (generally SBP above 90 mm/Hg).  Avoid hypervolemia.

  2. It should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency and in clinical states in which there exists edema with sodium retention.

  3. In patients with diminished renal function, administration of Normal Saline may result in sodium retention.


Adverse Reactions

  1. Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, and hypervolemia.

  2. If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save remainder of the fluid for examination if deemed necessary.


Interactions/Compatibility/Stability

  1. Compatible with most, if not all, EMS medications.  Check individual medications before administration.

  2. Avoid excessive heat. It is recommended the product be stored at room temp. (25`C) brief exposure up to 40`C does not adversely affect the product.


Special Considerations

Be aware that hypertonic (1.8%) and hypotonic (0.45%) saline solutions exist.  Ensure appropriate concentration before use.


Dosages

20cc/kg of lean body weight for hypovolemic hypotension.  Repeat once prn, then consider use of blood products.



Kinetics (IV)

Onset:    Immediate

Peak:      Immediate

Duration:    Until renal clearance occurs




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