Implementation of Hypertonic Saline Sliding Scale Protocol in a Neuroscience ICU

Cerebral edema, a complication that can occur in acute ischemic or hemorrhagic strokes, can lead to detrimental effects. Hypertonic saline therapy is use to obtain therapeutic hypernatremia to prevent further cerebral edema. In a neuroscience intensive care unit (ICU) setting, patients admitted with acute stroke and at risk for cerebral edema, are treated with hypertonic saline solution and the rate adjustment according to plasma serum sodium results every 4-6 hours. After a 10-day Reflective Practice Log, I gained insight of this issue. After a literature review, approval The University of Texas at El Paso Institutional Review Board (IRB), I started my Doctor of Nursing Practice (DNP) Project, “Implementation of Hypertonic Saline Scale Protocol in a Neuroscience ICU”. Evidence based guidelines founded hypertonic saline sliding scale protocol, allowed less time for undershooting or overshooting infusion rates. Permitted for serum plasma draw every 6 hours and included use of salt tablets with the hypertonic saline solution. Patients enrolled during this project, achieved serum sodium goal of 145mEq/L within a 24-hour period compared to previous, 36-52 hours range. In addition, the length of stay (LOS) decreased by 8 days, eliminated the complications from prolonged hypertonic saline infusion, lowered costs, and provided faster disposition