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H. Berkenstadt - One of the best experts on this subject based on the ideXlab platform.
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Intravenous Sodium Bicarbonate verifies intravenous position of catheters in ventilated children.
Anesthesia and analgesia, 2012Co-Authors: Ilan Keidan, Erez Ben-menachem, Sno Ellen White, H. BerkenstadtAbstract:Vascular access in children carries a significant risk of accidental extravasation of IV fluids and medications with the potential for tissue injury. In this prospective controlled study we assessed the diagnostic utility of using IV diluted Sodium Bicarbonate to confirm placement of IV catheters in ventilated children. Diluted Sodium Bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) Sodium Bicarbonate mixed in a 1:3 and 1:5 ratio with sterile water to achieve a final diluted concentration of 2.1% (0. 25 mEq/mL) and 1.05% (0.125 mEq/mL) Sodium Bicarbonate, respectively. In 18 ASA I-II mechanically ventilated children ages 1 to 8 years, the effects of 1 mL/kg of dilute 2.1%, 1.05% Sodium Bicarbonate, or 0.9% normal saline, injected in a randomized order, were analyzed. All children had oxygen saturation, arterial blood pressure, electrocardiograph, and end-tidal carbon dioxide (ETCO(2)) monitoring. In addition, venous blood samples were taken before injection and 10 minutes after the final injection for analysis of venous blood pH and electrolytes. In children, IV diluted 2.1% Sodium Bicarbonate resulted in significantly increased etco(2) (mean of 32.8 ± 3.4 mm Hg to 39.0 ± 3.5 mm Hg, P < 0.001), a mean increase of 6.2 mm Hg (95% prediction interval: 4.3 to 8.1 mm Hg) within 3 breaths. Intravenous diluted 1.05% Sodium Bicarbonate caused a less pronounced but still significant increase in etco(2) (33.4 ± 3.8 mm Hg to 36.3 ± 3.4 mm Hg, P < 0.001), a mean increase of 2.9 mm Hg (95% prediction interval: 1.8 to 4.1 mm Hg) within 3 breaths. Normal saline did not result in any significant changes, with a mean increase of 0.06 mm Hg (95% prediction interval: -1.3 to 1.4 mm Hg). Both concentrations of Sodium Bicarbonate were easily differentiated from normal saline injection by blinded anesthesiologists observing the change in etco(2) values immediately after injection. Analysis of pre- and postinjection venous pH, Bicarbonate, and Sodium levels could not detect clinically significant changes. A small but statistically significant increase in venous Bicarbonate was noted. The injection of 2.1% Sodium Bicarbonate in mechanically ventilated ASA I-II children identified intravascular placement and patency of an IV catheter by an increase in the exhaled CO(2) concentration. The injections did not have any clinically significant effects on blood pH, Bicarbonate, or Sodium concentration.
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intravenous Sodium Bicarbonate verifies intravenous position of catheters in ventilated patients
Anesthesia & Analgesia, 2011Co-Authors: Ilan Keidan, Erez Benmenachem, Aviv Barzilai, H. BerkenstadtAbstract:BACKGROUND: Extravasation is the unintentional injection or leakage of fluids into the perivascular or subcutaneous space resulting in potential tissue injury. In this 2-part prospective, controlled study, we assessed the safety of subcutaneously injected Sodium Bicarbonate in rats first. In the second part, the diagnostic utility of using IV diluted Sodium Bicarbonate to confirm placement of IV catheters in endotracheally intubated and ventilated rats and patients was tested. Diluted Sodium Bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) Sodium Bicarbonate mixed in a 1:1 ratio with sterile water to achieve a final diluted concentration of 4.2% (0.5 mEq/mL). METHODS: Sodium Bicarbonate (8.4% and 4.2%) was injected subcutaneously into 10 rats, and skin samples were evaluated. The hemodynamic and ventilatory effects of IV Bicarbonate (2 mL/kg) in ventilated rats were measured. Subsequently, in 20 ASA physical status I and II mechanically ventilated patients, the effects of 50 mL of diluted 4.2% Sodium Bicarbonate or 0.9% normal saline, injected in a randomized order, were analyzed. RESULTS: Part 1: Undiluted (8.4%) subcutaneous Sodium Bicarbonate resulted in a small area of skin necrosis in 10% of skin samples (3 of 30) taken from rats. Minimal effects (mild scale crust and foci of regenerative epidermis beneath) were detected when a diluted solution was used. In ventilated rats, IV injection of diluted Bicarbonate caused a significant increase in end-tidal carbon dioxide, whereas subcutaneous injection had no effect. In humans, diluted Bicarbonate resulted in an end-tidal carbon dioxide increase (mean of 38 ± 5 to 45 ± 7 mm Hg) within 7 breaths. Injected normal saline did not result in any changes. Sodium Bicarbonate was easily differentiated from normal saline injection by anesthesiologists observing the change in end-tidal carbon dioxide concentrations immediately after injection. CONCLUSION: The injection of diluted Sodium Bicarbonate (in mechanically ventilated patients) can be used to reliably identify the correct location of an IV catheter by an increase in the exhaled carbon dioxide concentration. Although we found no skin damage with 4.2% (0.5 mEq/mL) Sodium Bicarbonate, safety and efficacy should be further evaluated in future studies.
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intravenous Sodium Bicarbonate verifies intravenous position of catheters in ventilated children
Anesthesia & Analgesia, 2011Co-Authors: Ilan Keidan, Erez Benmenachem, Aviv Barzilai, H. BerkenstadtAbstract:BACKGROUND: Extravasation is the unintentional injection or leakage of fluids into the perivascular or subcutaneous space resulting in potential tissue injury. In this 2-part prospective, controlled study, we assessed the safety of subcutaneously injected Sodium Bicarbonate in rats first. In the second part, the diagnostic utility of using IV diluted Sodium Bicarbonate to confirm placement of IV catheters in endotracheally intubated and ventilated rats and patients was tested. Diluted Sodium Bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) Sodium Bicarbonate mixed in a 1:1 ratio with sterile water to achieve a final diluted concentration of 4.2% (0.5 mEq/mL). METHODS: Sodium Bicarbonate (8.4% and 4.2%) was injected subcutaneously into 10 rats, and skin samples were evaluated. The hemodynamic and ventilatory effects of IV Bicarbonate (2 mL/kg) in ventilated rats were measured. Subsequently, in 20 ASA physical status I and II mechanically ventilated patients, the effects of 50 mL of diluted 4.2% Sodium Bicarbonate or 0.9% normal saline, injected in a randomized order, were analyzed. RESULTS: Part 1: Undiluted (8.4%) subcutaneous Sodium Bicarbonate resulted in a small area of skin necrosis in 10% of skin samples (3 of 30) taken from rats. Minimal effects (mild scale crust and foci of regenerative epidermis beneath) were detected when a diluted solution was used. In ventilated rats, IV injection of diluted Bicarbonate caused a significant increase in end-tidal carbon dioxide, whereas subcutaneous injection had no effect. In humans, diluted Bicarbonate resulted in an end-tidal carbon dioxide increase (mean of 38 ± 5 to 45 ± 7 mm Hg) within 7 breaths. Injected normal saline did not result in any changes. Sodium Bicarbonate was easily differentiated from normal saline injection by anesthesiologists observing the change in end-tidal carbon dioxide concentrations immediately after injection. CONCLUSION: The injection of diluted Sodium Bicarbonate (in mechanically ventilated patients) can be used to reliably identify the correct location of an IV catheter by an increase in the exhaled carbon dioxide concentration. Although we found no skin damage with 4.2% (0.5 mEq/mL) Sodium Bicarbonate, safety and efficacy should be further evaluated in future studies.
Ilan Keidan - One of the best experts on this subject based on the ideXlab platform.
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Intravenous Sodium Bicarbonate verifies intravenous position of catheters in ventilated children.
Anesthesia and analgesia, 2012Co-Authors: Ilan Keidan, Erez Ben-menachem, Sno Ellen White, H. BerkenstadtAbstract:Vascular access in children carries a significant risk of accidental extravasation of IV fluids and medications with the potential for tissue injury. In this prospective controlled study we assessed the diagnostic utility of using IV diluted Sodium Bicarbonate to confirm placement of IV catheters in ventilated children. Diluted Sodium Bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) Sodium Bicarbonate mixed in a 1:3 and 1:5 ratio with sterile water to achieve a final diluted concentration of 2.1% (0. 25 mEq/mL) and 1.05% (0.125 mEq/mL) Sodium Bicarbonate, respectively. In 18 ASA I-II mechanically ventilated children ages 1 to 8 years, the effects of 1 mL/kg of dilute 2.1%, 1.05% Sodium Bicarbonate, or 0.9% normal saline, injected in a randomized order, were analyzed. All children had oxygen saturation, arterial blood pressure, electrocardiograph, and end-tidal carbon dioxide (ETCO(2)) monitoring. In addition, venous blood samples were taken before injection and 10 minutes after the final injection for analysis of venous blood pH and electrolytes. In children, IV diluted 2.1% Sodium Bicarbonate resulted in significantly increased etco(2) (mean of 32.8 ± 3.4 mm Hg to 39.0 ± 3.5 mm Hg, P < 0.001), a mean increase of 6.2 mm Hg (95% prediction interval: 4.3 to 8.1 mm Hg) within 3 breaths. Intravenous diluted 1.05% Sodium Bicarbonate caused a less pronounced but still significant increase in etco(2) (33.4 ± 3.8 mm Hg to 36.3 ± 3.4 mm Hg, P < 0.001), a mean increase of 2.9 mm Hg (95% prediction interval: 1.8 to 4.1 mm Hg) within 3 breaths. Normal saline did not result in any significant changes, with a mean increase of 0.06 mm Hg (95% prediction interval: -1.3 to 1.4 mm Hg). Both concentrations of Sodium Bicarbonate were easily differentiated from normal saline injection by blinded anesthesiologists observing the change in etco(2) values immediately after injection. Analysis of pre- and postinjection venous pH, Bicarbonate, and Sodium levels could not detect clinically significant changes. A small but statistically significant increase in venous Bicarbonate was noted. The injection of 2.1% Sodium Bicarbonate in mechanically ventilated ASA I-II children identified intravascular placement and patency of an IV catheter by an increase in the exhaled CO(2) concentration. The injections did not have any clinically significant effects on blood pH, Bicarbonate, or Sodium concentration.
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intravenous Sodium Bicarbonate verifies intravenous position of catheters in ventilated patients
Anesthesia & Analgesia, 2011Co-Authors: Ilan Keidan, Erez Benmenachem, Aviv Barzilai, H. BerkenstadtAbstract:BACKGROUND: Extravasation is the unintentional injection or leakage of fluids into the perivascular or subcutaneous space resulting in potential tissue injury. In this 2-part prospective, controlled study, we assessed the safety of subcutaneously injected Sodium Bicarbonate in rats first. In the second part, the diagnostic utility of using IV diluted Sodium Bicarbonate to confirm placement of IV catheters in endotracheally intubated and ventilated rats and patients was tested. Diluted Sodium Bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) Sodium Bicarbonate mixed in a 1:1 ratio with sterile water to achieve a final diluted concentration of 4.2% (0.5 mEq/mL). METHODS: Sodium Bicarbonate (8.4% and 4.2%) was injected subcutaneously into 10 rats, and skin samples were evaluated. The hemodynamic and ventilatory effects of IV Bicarbonate (2 mL/kg) in ventilated rats were measured. Subsequently, in 20 ASA physical status I and II mechanically ventilated patients, the effects of 50 mL of diluted 4.2% Sodium Bicarbonate or 0.9% normal saline, injected in a randomized order, were analyzed. RESULTS: Part 1: Undiluted (8.4%) subcutaneous Sodium Bicarbonate resulted in a small area of skin necrosis in 10% of skin samples (3 of 30) taken from rats. Minimal effects (mild scale crust and foci of regenerative epidermis beneath) were detected when a diluted solution was used. In ventilated rats, IV injection of diluted Bicarbonate caused a significant increase in end-tidal carbon dioxide, whereas subcutaneous injection had no effect. In humans, diluted Bicarbonate resulted in an end-tidal carbon dioxide increase (mean of 38 ± 5 to 45 ± 7 mm Hg) within 7 breaths. Injected normal saline did not result in any changes. Sodium Bicarbonate was easily differentiated from normal saline injection by anesthesiologists observing the change in end-tidal carbon dioxide concentrations immediately after injection. CONCLUSION: The injection of diluted Sodium Bicarbonate (in mechanically ventilated patients) can be used to reliably identify the correct location of an IV catheter by an increase in the exhaled carbon dioxide concentration. Although we found no skin damage with 4.2% (0.5 mEq/mL) Sodium Bicarbonate, safety and efficacy should be further evaluated in future studies.
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intravenous Sodium Bicarbonate verifies intravenous position of catheters in ventilated children
Anesthesia & Analgesia, 2011Co-Authors: Ilan Keidan, Erez Benmenachem, Aviv Barzilai, H. BerkenstadtAbstract:BACKGROUND: Extravasation is the unintentional injection or leakage of fluids into the perivascular or subcutaneous space resulting in potential tissue injury. In this 2-part prospective, controlled study, we assessed the safety of subcutaneously injected Sodium Bicarbonate in rats first. In the second part, the diagnostic utility of using IV diluted Sodium Bicarbonate to confirm placement of IV catheters in endotracheally intubated and ventilated rats and patients was tested. Diluted Sodium Bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) Sodium Bicarbonate mixed in a 1:1 ratio with sterile water to achieve a final diluted concentration of 4.2% (0.5 mEq/mL). METHODS: Sodium Bicarbonate (8.4% and 4.2%) was injected subcutaneously into 10 rats, and skin samples were evaluated. The hemodynamic and ventilatory effects of IV Bicarbonate (2 mL/kg) in ventilated rats were measured. Subsequently, in 20 ASA physical status I and II mechanically ventilated patients, the effects of 50 mL of diluted 4.2% Sodium Bicarbonate or 0.9% normal saline, injected in a randomized order, were analyzed. RESULTS: Part 1: Undiluted (8.4%) subcutaneous Sodium Bicarbonate resulted in a small area of skin necrosis in 10% of skin samples (3 of 30) taken from rats. Minimal effects (mild scale crust and foci of regenerative epidermis beneath) were detected when a diluted solution was used. In ventilated rats, IV injection of diluted Bicarbonate caused a significant increase in end-tidal carbon dioxide, whereas subcutaneous injection had no effect. In humans, diluted Bicarbonate resulted in an end-tidal carbon dioxide increase (mean of 38 ± 5 to 45 ± 7 mm Hg) within 7 breaths. Injected normal saline did not result in any changes. Sodium Bicarbonate was easily differentiated from normal saline injection by anesthesiologists observing the change in end-tidal carbon dioxide concentrations immediately after injection. CONCLUSION: The injection of diluted Sodium Bicarbonate (in mechanically ventilated patients) can be used to reliably identify the correct location of an IV catheter by an increase in the exhaled carbon dioxide concentration. Although we found no skin damage with 4.2% (0.5 mEq/mL) Sodium Bicarbonate, safety and efficacy should be further evaluated in future studies.
Matthijs De Hoog - One of the best experts on this subject based on the ideXlab platform.
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life threatening asthma in children treatment with Sodium Bicarbonate reduces pco2
Chest, 2005Co-Authors: Corinne Buysse, Johan C De Jongste, Matthijs De HoogAbstract:Objectives To assess the effect of administration of Sodium Bicarbonate on carbon dioxide levels in children with life-threatening asthma (LTA) and to evaluate the clinical effect of this treatment Study Design Retrospective study Setting A pediatric ICU (PICU) of a tertiary care university hospital Patients Seventeen children with LTA who received Sodium Bicarbonate Measurements and results In January 1999, a new protocol for the treatment of LTA was initiated in our institution, incorporating the use of IV Sodium Bicarbonate in acidotic patients (pH co 2 after Sodium Bicarbonate infusion (p = 0.007). An improvement of respiratory distress in all but one patient was seen as well Conclusions Administration of Sodium Bicarbonate in 17 children with LTA was associated with a significant decrease in P co 2 and an improvement of respiratory distress. The possible benefits of Sodium Bicarbonate in LTA deserve further study in a controlled, prospective design
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Clinical Investigations: AsthmaLife-Threatening Asthma in Children: Treatment With Sodium Bicarbonate Reduces Pco2
Chest, 2005Co-Authors: Corinne Buysse, Johan C De Jongste, Matthijs De HoogAbstract:Objectives To assess the effect of administration of Sodium Bicarbonate on carbon dioxide levels in children with life-threatening asthma (LTA) and to evaluate the clinical effect of this treatment Study Design Retrospective study Setting A pediatric ICU (PICU) of a tertiary care university hospital Patients Seventeen children with LTA who received Sodium Bicarbonate Measurements and results In January 1999, a new protocol for the treatment of LTA was initiated in our institution, incorporating the use of IV Sodium Bicarbonate in acidotic patients (pH co 2 after Sodium Bicarbonate infusion (p = 0.007). An improvement of respiratory distress in all but one patient was seen as well Conclusions Administration of Sodium Bicarbonate in 17 children with LTA was associated with a significant decrease in P co 2 and an improvement of respiratory distress. The possible benefits of Sodium Bicarbonate in LTA deserve further study in a controlled, prospective design
Belén Feriche - One of the best experts on this subject based on the ideXlab platform.
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Sodium Bicarbonate AND Sodium CITRATE
Journal of Strength and Conditioning Research, 2005Co-Authors: Bernardo Requena, Mikel Zabala, Paulino Padial, Belén FericheAbstract:ABSTRACTNumerous studies have used exogenous administration of Sodium Bicarbonate (NaHCO3) and Sodium citrate (Na-citrate) in an attempt to enhance human performance. After ingestion of NaHCO3 and Nacitrate, two observations have been made: (a) There was great individual variability in the ergogenic
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Sodium Bicarbonate and Sodium citrate ergogenic aids
Journal of Strength and Conditioning Research, 2005Co-Authors: Bernardo Requena, Mikel Zabala, Paulino Padial, Belén FericheAbstract:Requena, B., M. Zabala, P. Padial, and B. Feriche. Sodium Bicarbonate and Sodium citrate: Ergogenic aids? J. Strength Cond. Res. 19(1):213-224. 2005.—Numerous studies have used exogenous administration of Sodium Bicarbonate (NaHCO3) and Sodium citrate (Na-citrate) in an attempt to en- hance human performance. After ingestion of NaHCO3 and Na- citrate, two observations have been made: (a) There was great individual variability in the ergogenic benefit reached, which can be attributed to the level of physical conditioning of the sub- jects and to their tolerance of the buffer substance; and (b) the subjects who had ingested NaHCO3 and Na-citrate show higher levels of pH, Bicarbonate, and lactate ions concentrations in their exercising blood than do the subjects who had ingested the placebo. A majority of the studies have suggested that the in- gestion of both substances provides an ergogenic effect due to the establishment and maintenance of an elevated pH level dur- ing exercise. However, the exact mechanism by which the er- gogenic effects occur has not been demonstrated conclusively. Sodium Bicarbonate and Na-citrate seem to be effective in activ- ities with a sufficient duration to generate a difference in the hydrogen ion gradient, characterized by a very high intensity and involving large muscular groups. However, in activities of equally high intensity, but with longer duration, the results ob- tained have been conflicting and inconclusive.
Aviv Barzilai - One of the best experts on this subject based on the ideXlab platform.
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intravenous Sodium Bicarbonate verifies intravenous position of catheters in ventilated patients
Anesthesia & Analgesia, 2011Co-Authors: Ilan Keidan, Erez Benmenachem, Aviv Barzilai, H. BerkenstadtAbstract:BACKGROUND: Extravasation is the unintentional injection or leakage of fluids into the perivascular or subcutaneous space resulting in potential tissue injury. In this 2-part prospective, controlled study, we assessed the safety of subcutaneously injected Sodium Bicarbonate in rats first. In the second part, the diagnostic utility of using IV diluted Sodium Bicarbonate to confirm placement of IV catheters in endotracheally intubated and ventilated rats and patients was tested. Diluted Sodium Bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) Sodium Bicarbonate mixed in a 1:1 ratio with sterile water to achieve a final diluted concentration of 4.2% (0.5 mEq/mL). METHODS: Sodium Bicarbonate (8.4% and 4.2%) was injected subcutaneously into 10 rats, and skin samples were evaluated. The hemodynamic and ventilatory effects of IV Bicarbonate (2 mL/kg) in ventilated rats were measured. Subsequently, in 20 ASA physical status I and II mechanically ventilated patients, the effects of 50 mL of diluted 4.2% Sodium Bicarbonate or 0.9% normal saline, injected in a randomized order, were analyzed. RESULTS: Part 1: Undiluted (8.4%) subcutaneous Sodium Bicarbonate resulted in a small area of skin necrosis in 10% of skin samples (3 of 30) taken from rats. Minimal effects (mild scale crust and foci of regenerative epidermis beneath) were detected when a diluted solution was used. In ventilated rats, IV injection of diluted Bicarbonate caused a significant increase in end-tidal carbon dioxide, whereas subcutaneous injection had no effect. In humans, diluted Bicarbonate resulted in an end-tidal carbon dioxide increase (mean of 38 ± 5 to 45 ± 7 mm Hg) within 7 breaths. Injected normal saline did not result in any changes. Sodium Bicarbonate was easily differentiated from normal saline injection by anesthesiologists observing the change in end-tidal carbon dioxide concentrations immediately after injection. CONCLUSION: The injection of diluted Sodium Bicarbonate (in mechanically ventilated patients) can be used to reliably identify the correct location of an IV catheter by an increase in the exhaled carbon dioxide concentration. Although we found no skin damage with 4.2% (0.5 mEq/mL) Sodium Bicarbonate, safety and efficacy should be further evaluated in future studies.
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intravenous Sodium Bicarbonate verifies intravenous position of catheters in ventilated children
Anesthesia & Analgesia, 2011Co-Authors: Ilan Keidan, Erez Benmenachem, Aviv Barzilai, H. BerkenstadtAbstract:BACKGROUND: Extravasation is the unintentional injection or leakage of fluids into the perivascular or subcutaneous space resulting in potential tissue injury. In this 2-part prospective, controlled study, we assessed the safety of subcutaneously injected Sodium Bicarbonate in rats first. In the second part, the diagnostic utility of using IV diluted Sodium Bicarbonate to confirm placement of IV catheters in endotracheally intubated and ventilated rats and patients was tested. Diluted Sodium Bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) Sodium Bicarbonate mixed in a 1:1 ratio with sterile water to achieve a final diluted concentration of 4.2% (0.5 mEq/mL). METHODS: Sodium Bicarbonate (8.4% and 4.2%) was injected subcutaneously into 10 rats, and skin samples were evaluated. The hemodynamic and ventilatory effects of IV Bicarbonate (2 mL/kg) in ventilated rats were measured. Subsequently, in 20 ASA physical status I and II mechanically ventilated patients, the effects of 50 mL of diluted 4.2% Sodium Bicarbonate or 0.9% normal saline, injected in a randomized order, were analyzed. RESULTS: Part 1: Undiluted (8.4%) subcutaneous Sodium Bicarbonate resulted in a small area of skin necrosis in 10% of skin samples (3 of 30) taken from rats. Minimal effects (mild scale crust and foci of regenerative epidermis beneath) were detected when a diluted solution was used. In ventilated rats, IV injection of diluted Bicarbonate caused a significant increase in end-tidal carbon dioxide, whereas subcutaneous injection had no effect. In humans, diluted Bicarbonate resulted in an end-tidal carbon dioxide increase (mean of 38 ± 5 to 45 ± 7 mm Hg) within 7 breaths. Injected normal saline did not result in any changes. Sodium Bicarbonate was easily differentiated from normal saline injection by anesthesiologists observing the change in end-tidal carbon dioxide concentrations immediately after injection. CONCLUSION: The injection of diluted Sodium Bicarbonate (in mechanically ventilated patients) can be used to reliably identify the correct location of an IV catheter by an increase in the exhaled carbon dioxide concentration. Although we found no skin damage with 4.2% (0.5 mEq/mL) Sodium Bicarbonate, safety and efficacy should be further evaluated in future studies.
