Why 0.9% Isotonic Sodium Chloride in 500 mL Flexible Bags for Safe IV Hydration

The 0.9% sodium chloride concentration (9 grams per liter, 154 mEq/L each of sodium and chloride) creates an isotonic solution with osmolality approximately 308 mOsm/L—matching the osmolality of human plasma and extracellular fluid, preventing the cellular swelling that occurs with hypotonic solutions or cellular shrinkage caused by hypertonic solutions, critical for maintaining cellular integrity during fluid resuscitation, medication dilution, and routine hydration where osmotic balance must be preserved to prevent complications like hemolysis, cerebral edema, or cellular dehydration. Normal saline represents the most widely used crystalloid solution in clinical medicine because its electrolyte composition—containing only sodium and chloride without other ions like potassium, calcium, or lactate—provides straightforward fluid replacement without complicating existing electrolyte imbalances, making it the safest first-line choice when precise electrolyte manipulation is not required and the primary goal is volume expansion, vascular filling, or creating an intravenous vehicle for medication administration. The 500 mL flexible plastic bag volume enables precise fluid administration for moderate hydration needs, medication dilution protocols, and perioperative fluid management while remaining manageable for single-patient use without the waste associated with larger liter bags or the inconvenience of multiple small-volume bottles, while the flexible container design eliminates air venting requirements needed with rigid glass bottles, reduces storage space compared to semi-rigid containers, and allows easier visual inspection for particulate matter or solution clarity throughout the infusion.

Key Features & Benefits

Key Features:

• 0.9% sodium chloride concentration (isotonic)
• 500 mL volume per flexible bag
• Sterile, nonpyrogenic solution
• Preservative-free formulation
• pH approximately 4.5-7.0 (typically 5.0-5.5)
• Osmolality approximately 308 mOsm/L
• Contains 154 mEq/L sodium and 154 mEq/L chloride
• Flexible plastic container (PVC or non-PVC)
• Two ports: administration port and medication additive port
• Clear, colorless solution for visual inspection
• No antimicrobial or bacteriostatic agents
• Room temperature stable
• Overwrap protects until ready for use
• Single-use container
• Latex-free construction
• DEHP-free options available (check product specifications)
• Manufactured by B. Braun (trusted healthcare supplier)

Benefits:

• Isotonic prevents cellular osmotic damage
• Safe for routine IV hydration and fluid replacement
• Sodium and chloride replace common losses
• No complex electrolytes simplifies use
• Appropriate for wide range of clinical situations
• 500 mL size enables precise dosing
• Flexible container reduces storage space
• No air venting required (vs. glass bottles)
• Easy to hang and administer
• Medication port allows additive incorporation
• Visual inspection through clear plastic
• Sterile ensures infection control
• Nonpyrogenic prevents fever reactions
• Preservative-free optimal for IV use
• Room temperature storage convenient
• Single-use prevents contamination

Clinical Applications

B. Braun 0.9% Sodium Chloride Injection is appropriate for:

✓ Hypovolemia and dehydration treatment ✓ Fluid resuscitation in trauma or shock ✓ Perioperative fluid management ✓ Post-operative hydration ✓ Maintenance IV fluid therapy ✓ NPO (nothing by mouth) patient hydration ✓ Electrolyte replacement (sodium and chloride) ✓ Hypochloremic metabolic alkalosis treatment ✓ IV medication dilution and delivery ✓ IV flush for medication administration ✓ Priming IV tubing and equipment ✓ Emergency department fluid therapy ✓ Critical care volume expansion ✓ Pediatric IV hydration (with appropriate calculations) ✓ Geriatric fluid replacement ✓ Blood transfusion priming and flushing ✓ Dialysis procedures ✓ Any clinical situation requiring isotonic IV fluid

Usage & Application

IMPORTANT: This product must be prescribed by healthcare provider and administered by qualified clinical personnel only.

Pre-Administration Assessment:

1. Verify order:
   • Confirm 0.9% sodium chloride prescribed
   • Check volume (500 mL)
   • Verify rate of administration
   • Review any additives ordered
   • Confirm patient identity
2. Patient assessment:
   • Assess fluid status (dehydration vs. overload)
   • Check blood pressure, heart rate
   • Review laboratory values:
     • Sodium level
     • Chloride level
     • Potassium level (saline doesn't contain potassium)
     • Renal function
     • Acid-base status
   • Review medical history:
     • Heart failure
     • Renal disease
     • Liver disease
     • Hypertension
   • Assess for contraindications
3. Contraindications—Do NOT administer if:
   • Hypernatremia (elevated sodium)
   • Hyperchloremia (elevated chloride)
   • Fluid overload or pulmonary edema
   • Severe renal impairment with oliguria/anuria
   • Hyperosmolar state
4. Use with caution if patient has:
   • Heart failure (risk of fluid overload)
   • Renal insufficiency
   • Hypertension
   • Edema
   • Cirrhosis with ascites
   • Elderly patients (more prone to fluid overload)
   • Preeclampsia

Preparation:

1. Inspect solution:
   • Remove overwrap just before use
   • Inspect bag for:
     • Leaks (squeeze bag firmly)
     • Cloudiness or discoloration (should be crystal clear)
     • Particulate matter
     • Intact ports and seals
   • Discard if:
     • Leaking
     • Cloudy or discolored
     • Contains particles
     • Bag damaged
     • Solution frozen (thaw at room temperature if accidentally frozen)
2. Check expiration date:
   • Do not use if expired
3. Prepare for administration:
   • Gather IV administration set
   • IV pump (if precise rate needed)
   • Alcohol swabs
   • IV pole
   • Gloves
   • Any prescribed additives
4. Adding medications (if ordered):
   • Use aseptic technique
   • Clean medication additive port with alcohol
   • Inject medication through port
   • Mix thoroughly:
     • Invert bag several times
     • Ensure complete distribution throughout solution
   • Label bag clearly:
     • Medication name and dose
     • Date and time added
     • Initials
   • Verify compatibility:
     • Check medication compatible with normal saline
     • Some medications incompatible

Administration:

1. Establish IV access:
   • Peripheral IV catheter or central line
   • Verify patency before connecting
2. Hang solution:
   • Remove protective cover from administration port
   • Insert administration set spike:
     • Close roller clamp first
     • Remove protective cap from spike
     • Insert spike into port
     • Hang bag on IV pole
3. Prime tubing:
   • Squeeze drip chamber to fill halfway
   • Open roller clamp
   • Allow solution to flow through tubing
   • Remove all air bubbles
   • Close clamp once primed
4. Connect to patient:
   • Clean IV catheter hub with alcohol
   • Connect tubing to IV access
   • Secure connection
5. Set infusion rate:
   • Rate determined by:
     • Patient's clinical condition
     • Degree of dehydration
     • Age and weight
     • Cardiac and renal function
     • Provider order
   • Typical rates:
     • Maintenance: 75-125 mL/hour adults
     • Moderate dehydration: 125-250 mL/hour
     • Severe dehydration/shock: Wide open or per protocol
     • Pediatric: Calculate based on weight and condition
   • Use infusion pump for:
     • Precise rate control
     • Pediatric patients
     • Cardiac or renal patients
     • Prevention of fluid overload
6. Secure tubing:
   • Tape or secure to prevent pulling
   • Label tubing with date and time

Monitoring During Administration:

1. Vital signs:
   • Monitor blood pressure, heart rate, respiratory rate
   • Every 15-30 minutes initially in acute situations
   • Per facility protocol for maintenance therapy
   • Watch for:
     • Hypertension (fluid overload)
     • Tachycardia
     • Dyspnea (fluid in lungs)
2. Fluid status:
   • Intake and output strictly:
     • Document all fluids given
     • Monitor urine output (should increase with hydration)
     • Calculate fluid balance
   • Watch for fluid overload:
     • Dyspnea, orthopnea
     • Crackles on lung auscultation
     • Peripheral edema
     • Jugular venous distension
     • Weight gain
   • Watch for inadequate hydration:
     • Continued low urine output
     • Tachycardia
     • Low blood pressure
     • Poor skin turgor
3. Laboratory monitoring:
   • Electrolytes:
     • Sodium level (watch for hypernatremia)
     • Chloride level (watch for hyperchloremia)
     • Potassium level (normal saline doesn't contain potassium—may need supplementation)
   • Renal function:
     • BUN, creatinine
     • Urine output
   • Acid-base status:
     • Normal saline can cause hyperchloremic metabolic acidosis with large volumes
     • Monitor pH if giving large amounts
4. IV site assessment:
   • Check every 1-2 hours
   • Watch for infiltration:
     • Swelling around site
     • Coolness
     • Pain
     • Slowed infusion rate
   • Watch for phlebitis:
     • Redness
     • Warmth
     • Pain along vein
     • Palpable cord
   • Discontinue if complications occur
5. Patient symptoms:
   • Dyspnea or respiratory distress
   • Chest discomfort
   • Headache
   • Confusion (electrolyte imbalance)

Discontinuation:

1. When to stop:
   • Infusion complete
   • Patient adequately hydrated
   • Adverse reaction occurs
   • Provider orders discontinuation
   • IV site compromised
2. Procedure:
   • Close roller clamp
   • Remove tubing from IV catheter (or discontinue IV)
   • Dispose of bag and tubing per facility protocol
   • Document total volume infused

Post-Administration Care:

1. Final documentation:
   • Total volume infused
   • Patient tolerance
   • Vital signs and assessment
   • Laboratory results
   • Any complications
2. Dispose properly:
   • Empty bags in appropriate waste
   • Follow facility disposal protocols

Storage:

Before Use:

• Store at room temperature 20-25°C (68-77°F)
• Excursions permitted 15-30°C (59-86°F)
• Protect from freezing
• Protect from excessive heat
• Keep in moisture barrier overwrap until ready to use
• Brief exposure to 40°C acceptable

Shelf Life:

• Check expiration date on bag
• Typically 18-24 months from manufacture

Do NOT use if:

• Expired
• Cloudy or discolored
• Contains particulates
• Bag leaking
• Seal compromised

Troubleshooting:

Infusion running too slowly:

• Check for kinks in tubing
• Verify clamps open
• Check IV site for infiltration
• Reposition patient's arm
• Verify pump settings

Fluid overload developing:

• Signs:
  • Dyspnea
  • Crackles in lungs
  • Edema
  • Hypertension
  • Distended neck veins
• Actions:
  • Slow or stop infusion
  • Notify provider immediately
  • Elevate head of bed
  • Assess respiratory status
  • May need diuretics
  • Monitor oxygen saturation

Infiltration:

• Stop infusion immediately
• Remove IV catheter
• Elevate extremity
• Apply warm compress
• Assess tissue damage
• Restart in different location

Hypernatremia (elevated sodium):

• May occur with excessive normal saline
• Symptoms: confusion, seizures, coma
• Check sodium levels
• Notify provider
• May need to switch to hypotonic fluid

Hyperchloremic metabolic acidosis:

• Can occur with large volumes of normal saline
• Normal saline has high chloride content
• Monitor acid-base status
• May need to use balanced crystalloid instead
• Notify provider if pH decreasing

Special Considerations:

Pediatric patients:

• Calculate fluid rate by weight
• Typical: 4 mL/kg/hr for first 10 kg, 2 mL/kg/hr for next 10 kg, 1 mL/kg/hr for remaining kg
• Monitor closely (children more prone to fluid overload)
• Use infusion pump mandatory
• Smaller volumes may be appropriate

Geriatric patients:

• More prone to fluid overload
• May have reduced cardiac reserve
• May have renal insufficiency
• Monitor carefully
• Slower infusion rates often appropriate
• Daily weights important

Cardiac patients:

• Risk of fluid overload and heart failure exacerbation
• Monitor for dyspnea, edema
• Conservative fluid administration
• May need diuretics concurrently
• Daily weights critical

Renal patients:

• Reduced ability to excrete sodium and water
• Fluid overload risk high
• May need reduced volumes
• Monitor intake/output strictly
• Watch electrolytes closely

Liver disease/cirrhosis:

• May have ascites and edema already
• Fluid overload risk
• May need restricted volumes
• Monitor for worsening ascites

Hypertensive patients:

• Sodium load may worsen hypertension
• Monitor blood pressure closely
• May need alternative fluid

Trauma/shock:

• Normal saline commonly used for resuscitation
• Large volumes may be needed
• Monitor for hyperchloremic acidosis with massive resuscitation
• May alternate with other fluids

Diabetic ketoacidosis:

• Normal saline standard initial fluid
• Large volumes typically needed
• Switch to dextrose-containing fluid when glucose <250 mg/dL
• Monitor electrolytes closely (especially potassium)

Pregnancy:

• Generally safe
• Monitor for fluid overload
• Appropriate for labor and delivery

Additives Commonly Mixed with Normal Saline:

• Electrolytes:
  • Potassium chloride (verify concentration safe)
  • Calcium gluconate
  • Magnesium sulfate
• Medications:
  • Antibiotics (many compatible)
  • Analgesics
  • Many IV medications
• Always verify compatibility before mixing

Incompatibilities:

• Some medications incompatible with normal saline
• Check drug compatibility references
• Never mix incompatible substances

Normal Saline vs. Other IV Fluids:

Normal Saline (0.9% NaCl) vs. Lactated Ringer's:

• Normal Saline:
  • Only sodium and chloride
  • No potassium (good for hyperkalemia)
  • Can cause hyperchloremic acidosis
  • Simple composition
• Lactated Ringer's:
  • Contains potassium, calcium, lactate
  • More "balanced" electrolytes
  • Lactate metabolized to bicarbonate (buffering)
  • Contraindicated in hyperkalemia

Normal Saline vs. Dextrose Solutions:

• Normal Saline:
  • No calories
  • For hydration and sodium replacement
  • Isotonic
• Dextrose 5% in Water (D5W):
  • Provides calories
  • Free water (dextrose metabolized)
  • Becomes hypotonic after dextrose metabolized
  • For hydration with calorie needs

Normal Saline vs. Balanced Crystalloids:

• Balanced crystalloids (Plasma-Lyte, Normosol):
  • Lower chloride content
  • May reduce risk of hyperchloremic acidosis
  • More expensive
  • Increasingly used in large-volume resuscitation

When to Use Normal Saline:

• General hydration
• Fluid resuscitation (most common first-line)
• Hypochloremic alkalosis
• Hyponatremia (with caution)
• As medication vehicle
• When simple fluid replacement needed

When to Contact Provider:

Immediately:

• Signs of severe fluid overload (respiratory distress)
• Chest pain
• Altered mental status
• Severe electrolyte abnormalities
• Allergic reaction (rare but possible)

Soon:

• Mild fluid overload signs
• Infiltration not resolving
• Electrolyte imbalances
• Patient not improving with hydration
• Questions about rate or continuation

Regulatory Information:

• FDA-approved IV solution
• USP (United States Pharmacopeia) grade
• Manufactured under cGMP (current Good Manufacturing Practices)
• Nonpyrogenic per USP standards
• Sterile per USP standards

Technical Specifications

Product Details:

• Manufacturer: B. Braun Medical Inc.
• Product Name: 0.9% Sodium Chloride Injection, USP (Normal Saline)
• Concentration: 0.9% w/v (0.9 grams per 100 mL, 9 grams per liter)
• Volume: 500 mL per bag
• Container: Flexible plastic bag (PVC or non-PVC options)
• Osmolality: Approximately 308 mOsm/L (isotonic)
• pH: Approximately 4.5-7.0 (typically 5.0-5.5)
• Electrolyte Content:
  • Sodium: 154 mEq/L
  • Chloride: 154 mEq/L
• Solution Appearance: Clear, colorless
• Sterility: Sterile
• Pyrogenicity: Nonpyrogenic
• Preservatives: None (preservative-free)
• Antimicrobial Agents: None
• Bacteriostatic Agents: None
• Ports: Administration port and medication additive port
• Overwrap: Moisture barrier until ready for use
• Latex Content: Latex-free
• DEHP: Check specific product (DEHP-free options available)
• Intended Use: Intravenous administration only
• Single Use: Discard unused portion
• Storage: Room temperature 20-25°C (68-77°F)
• Shelf Life: Check expiration (typically 18-24 months)
• Regulatory Status: FDA-approved drug product
• USP Designation: 0.9% Sodium Chloride Injection, USP