Intraosseous Administration of 23.4% NaCl for Treatment of Intracranial Hypertension

Neurocrit Care. 2019 Apr;30(2):364-371. doi: 10.1007/s12028-018-0637-2.


Background/objective: Prompt treatment of acute intracranial hypertension is vital to preserving neurological function and frequently includes administration of 23.4% NaCl. However, 23.4% NaCl administration requires central venous catheterization that can delay treatment. Intraosseous catheterization is an alternative route of venous access that may result in more rapid administration of 23.4% NaCl.

Methods: Single-center retrospective analysis of 76 consecutive patients, between January 2015 and January 2018, with clinical signs of intracranial hypertension received 23.4% NaCl through either central venous catheter or intraosseous access.

Results: Intraosseous cannulation was successful on the first attempt in 97% of patients. No immediate untoward effects were seen with intraosseous cannulation. Time to treatment with 23.4% NaCl was significantly shorter in patients with intraosseous access compared to central venous catheter (p < 0.0001).

Conclusions: Intraosseous cannulation resulted in more rapid administration of 23.4% NaCl with no immediate serious complications. Further investigations to identify the clinical benefits and safety of hypertonic medication administration via intraosseous cannulation are warranted.

Keywords: Brain herniation; Central venous catheter; Hypertonic saline; Intracranial hypertension; Intraosseous cannulation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Central Venous Catheters*
  • Female
  • Humans
  • Infusions, Intraosseous*
  • Intracranial Hypertension / therapy*
  • Male
  • Middle Aged
  • Process Assessment, Health Care*
  • Retrospective Studies
  • Saline Solution, Hypertonic / administration & dosage*


  • Saline Solution, Hypertonic