Safety of peripheral intravenous administration of hypertonic saline: a systematic review and meta-analysis
Bibliographic record
Abstract
Background: Hypertonic saline solution is critical for managing symptomatic hyponatremia and increased intracranial pressure (IICP). Though administered via central venous catheters (CVCs) traditionally, peripheral administration is a viable alternative, reducing delays and CVC-associated risks. This review evaluates the safety of peripheral hypertonic saline, focusing on infusion-related adverse events. Methods: A systematic search of MEDLINE, Embase, and Cochrane Library (up to December 2024) identified studies on peripheral hypertonic saline in adults. Studies reporting phlebitis, infiltration, extravasation, and thrombosis were included. Two reviewers independently screened studies and extracted data. Quality was assessed using the Newcastle-Ottawa Scale and Risk of Bias 2 tool. The review is registered on PROSPERO (CRD42024612330). Results: Thirteen studies involving 2,354 patients were included, comprising one randomized controlled trial and 12 cohort studies. Quality assessment showed a low risk of bias across all included studies. The pooled incidence of phlebitis was 2.3% (95% CI: 1.2%-4.1%), while infiltration and extravasation occurred at a rate of 2.1% (95% CI: 1.1%-3.9%). Thrombosis was rare, with an incidence of 0.8% (95% CI: 0.3%-1.7%). Most complications were mild and resolved conservatively. Conclusion: Peripheral hypertonic saline is a safe alternative to CVC placement, particularly in urgent situations where rapid intervention is required. Low complication rates support its broader use in clinical practice, enabling timely treatment while minimizing the risks associated with central access. These findings support consideration for updates to clinical guidelines, advocating for peripheral hypertonic saline as a first-line option in appropriate scenarios to enhance patient outcomes and streamline care delivery. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42024612330.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.027 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".