What is your policy for dispensing and/or storing 23.4% sodium chloride on nursing units? Do you stock in ADCs? Do you allow this to be on override status? Do you monitor overrides to ensure scheduled doses are being pulled by patient and not override? Do you identify in some way that this is a concentrated product? Do you have a policy for heparin use in patients with delayed neurological deficit? Do you have an order set for heparin in DND?
Would you be willing to share? Are your APPs allowed to order either 23.4% sod chloride or heparin for DND or is it restricted to neurosurgeons?

We have a new neurosurgeon pushing our boundaries on stocking 23.4% sodium chloride in the neuro ICU ADC and developing a neuro emergency box containing 23.4% sodium chloride. Supposedly this was done at the sites he has trained (Univ Maryland, Johns Hopkins, Rochester). If anyone at these institutions has a protocol or policy or even practices you have developed, I would appreciate leaning how he has been trained.

I would also appreciate experiences from other institutions to understand how this is being managed. We are all for helping our providers take the best care of patients but want to ensure it is done safely. Thank you for any help!

Carol Labadie
Vidant Medical Center
Greenville, NC