DUHS Policy for 1.8% and 3% Saline Administration

Administration

1. Administration
   Confirm order for 1.8% saline or 3% saline infusion (order to be written in
   mL/hour)*
   1. Provider may order 1.8% or 3% boluses in the setting of symptomatic
      hyponatremia. Boluses may only be administered in an intensive care
      or emergency department setting.
2. Confirm appropriate level of care
   1. Inpatients receiving infusion of 1.8% saline may be managed in
      floor/routine setting. An increase in level of care may be necessary if
      frequency of sodium monitoring exceeds monitoring available in
      floor/routine setting
   2. Inpatients receiving infusion of 3% saline will be managed in the ICU at
      DRH. Inpatients may be managed on either stepdown/telemetry or ICU at
      DUH & DRAH.
3. Ensure appropriate venous access for administration
   1. 1.8% may be administered via peripheral or central line
   2. Central venous access (including peripherally inserted central catheters) is
      preferred for administration of 3% saline due to high osmolarity and
      tonicity. In the absence of central venous access, 3% saline may be
      administered via peripheral line with provider order.*
4. Continuous infusions and bolus doses of hypertonic saline must be administered
   via infusion pump utilizing the drug library.
5. Monitoring of serum sodium is per physician/physician designee order