Hartman, Alex M, BSN, RN

Holly, Taylor A, BSN, RN

Matina, Courtney N, BSN, RN

Sabatino, Michelle G, BSN, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingManagement of Increased Intracranial Pressurewith 23.4% Saline in the Adult NeurologicallyInjured Patient PopulationTaylor A. Holly BSN, RNLehigh Valley Health Network, taylor_a.holly@lvhn.orgCourtney N. Matina BSN, RNLehigh Valley Health Network, courtney_n.matina@lvhn.orgMichelle G. Sabatino BSN, RNLehigh Valley Health Network, michelle_g.sabatino@lvhn.orgAlex M. Hartman BSN, RNLehigh Valley Health Network, alex_m.hartman@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHolly, T., Matina, C., Sabatino, M., & Hartman, A. (2016, July 20). Management of Increased Intracranial Pressure with 23.4% Saline inthe Adult Neurologically Injured Patient Population. Poster presented at LVHN Vizient/AACN Nurse Residency Program Graduation,Lehigh Valley Health Network, Allentown, PA.© 2014 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaManagement of Increased Intracranial Pressure with 23.4% Saline in the Adult Neurologically Injured Patient Population • Meet with NSICU physicians to create an algorithm for the use of 3% vs 23.4% saline• Contacted pharmacy to obtain 23.4% HSS • Submit algorithm and policy to administration for final approval• Begin usage of 23.4% saline per physician order• Once 23.4% algorithm is approved, NSICU nurses will be educated on algorithm and the use of a bolus. • Patient ICP readings will be monitored to evaluate the effectiveness of 23.4% saline boluses in rapidly reducing ICP.• Hypertonic saline policy will be updated to include the use of 23.4% saline boluses in addition to a continuous infusion of 3% saline infusionTaylor Holly, BSN, RN, Courtney Matina, BS-RN, Michelle Sabatino, BSN, RN, and Alex Hartman, BSN, RNBackground/SignificanceProcess/ImplementationAlgorithm EvidenceDissemination• Hypertonic saline (HTS) is any concentration of sodium chloride higher than physiologic (0.9%)• Hypertonic saline is used to achieve a state of hyperosmolarity• By increasing serum sodium osmolality, HTS creates an osmotic gradient that pulls water from the intracellular compartments of the brain, reducing intracranial pressure (Froelich, Quanhong,Wess, Ougorets, & Hartl, 2009)• It also leads to an increase in cerebral blood flow by reducing vascular resistance due to the decreased edema in the brain’s vasculature (Froelich et al. 2009)• Studies showed that with the use of a 23.4% saline bolus, the reduction in ICP from the baseline (within 6 hours after the bolus HTS treatment) was statistically significant; the mean reduction from baseline to follow-up values was 8.8 mm Hg (Paredes-Andrade et al. 2014)• Treatment of refractory intracranial hypertension with 23.4% salineshows ICP was more than halved after the bolus administration (Bodel et al. 2013)• A 30 ml bolus of 23.4% saline is the standard dose for emergent reduction of ICP (Kimberly & Sheth, 2011).• HTS is associated with ICP reduction and reversal of transtentorial herniation (Stevens, Huff, Duckworth, Papangelou, Weingart, & Smith, 2012).PICO QuestionIn the adult neurologically brain injured population is a bolus of 23.4% saline more efficacious than a continuous infusion of 3% NSS to reduce elevated intracranial pressure readings?

Management of Increased Intracranial Pressure with 23.4% Saline in the Adult Neurologically Injured Patient Population

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1666&context=patient-care-services-nursing

Management of Increased Intracranial Pressure with 23.4% Saline in the Adult Neurologically Injured Patient Population

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