Objective:

To evaluate the time from 23.4% NaCl order to administration for cerebral edema treatment after transition from centralized dispensing to on-unit automated dispensing cabinets.

Background:

Cerebral edema, the accumulation of excess fluid in the brain's cells or extravascular space, is a severe complication of neurologic injuries (e.g., hemorrhage, infection, metabolic disturbances, intracranial tumors). As the brain swells, intracranial pressure increases and can result in brain herniation and death if not treated urgently. Current guidelines from the Neurocritical Care Society suggest that hypertonic saline is effective in reducing cerebral edema and intracranial pressure in patients with acute neurologic injuries. In January 2024, a tertiary care center transitioned to the availability of 23.4% NaCl in on-unit automated dispensing cabinets to aid in decreasing the time from order to administration for urgent situations such as cerebral edema.

Design/Methods:

Results:

Median time from order to administration decreased by 16 minutes post-intervention. Peripheral line administration was used more frequently post-intervention (54.5% vs 14.3%), while the placement of central lines for administration decreased (45.5% vs 85.7%). When peripheral lines were utilized, median time from order to administration was ~5 minutes faster post-intervention. Controlling for line access, median time from order to administration showed a statistically significant decrease by a median of 13 minutes (95% CI: 3.4, 22.7 minutes; p=0.010) post-intervention. 

Conclusions:

When discussing hypertonic solutions in the setting of cerebral edema and impending herniation, every minute counts. Readily accessible on-unit automated dispensing cabinets for hypertonic saline, in addition to peripheral access administration, reduce time to administration.