Indian Journal of Critical Care Case Report

Register      Login

VOLUME 3 , ISSUE 2 ( March-April, 2024 ) > List of Articles


Untwisting an Outward Form of Nitroglycerin for Radial Artery Cannulation: A Case Report

Shashikant Sharma, Gourav Mittal, Abhijeet Anand, Tanweer Qamar, Kishore Jhunjhunwala

Keywords : Case report, Invasive blood pressure, Nitroglycerin, Radial artery, Septic shock, Ultrasound

Citation Information : Sharma S, Mittal G, Anand A, Qamar T, Jhunjhunwala K. Untwisting an Outward Form of Nitroglycerin for Radial Artery Cannulation: A Case Report. 2024; 3 (2):51-53.

DOI: 10.5005/jp-journals-11006-0099

License: CC BY-NC 4.0

Published Online: 15-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Arterial cannulation for invasive blood pressure monitoring and titration of vasopressors in patients with septic shock is a recommended practice in intensive care units. The radial artery, being superficial, easily accessible, and associated with fewer complications, makes it the first choice for invasive blood pressure monitoring. Using ultrasound increases the chances of successful cannulation on the first attempt. However, in patients with septic shock, strong sympathetic stimulation and the use of vasopressors cause severe spasms and make arterial cannulation difficult even under ultrasound guidance. We report a case of successful radial artery cannulation in the first pass using intra-arterial nitroglycerin in a 24-year-old female admitted with septic shock and on high doses of dual vasopressors.

PDF Share
  1. Fleischmann-Struzek C, Mellhammar L, Rose N, et al. Incidence and mortality of hospital-and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. Int Care Med 2020;46(8):1552–1562. DOI: 10.1007/s00134-020-06151-x
  2. Evans L, Rhodes A, Alhazzani W, et al. Executive summary: surviving sepsis campaign: international guidelines for the management of sepsis and septic shock 2021. Crit Care Med 2021;49(11):1974–1982. DOI: 10.1097/CCM.0000000000005357
  3. Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesthe Analg 2009;109(6):1763–1781. DOI: 10.1213/ANE.0b013e3181bbd416
  4. Shiloh AL, Savel RH, Paulin LM, et al. Ultrasound-guided catheterization of the radial artery: a systematic review and meta-analysis of randomized controlled trials. Chest 2011;139(3):524–549. DOI: 10.1378/chest.10-0919
  5. Ruzsa Z, Szolnoky J. Radial artery cannulation: a systemic review. J Anesthe Clinic Res 2012;4(3). DOI: 10.4172/2155-6148.1000313
  6. Ignarro LJ. After 130 years, the molecular mechanism of action of nitroglycerin is revealed. Proceed Nat Acad Sci 2002 Jun 11;99(12):7816–7817. DOI: 10.1073/pnas.132271799
  7. Majure DT, Hallaux M, Yeghiazarians Y, et al. Topical nitroglycerin and lidocaine locally vasodilate the radial artery without affecting systemic blood pressure: a dose-finding phase I study. J Crit Care 2012;27(5):532.e9–e13. DOI: 10.1016/j.jcrc.2012.04.019
  8. Baserga MC, Puri A, Sola A. The use of topical nitroglycerin ointment to treat peripheral tissue ischemia secondary to arterial line complications in neonates. J Perinatol 2002;22(5):416–419. DOI: 10.1038/
  9. Men X, Wang Q, Chen P, et al. Subcutaneous nitroglycerin increased the success rate of radial artery cannulation in women with gestational hypertension undergoing cesarean section: a randomized controlled trial. Die Anaesthesiol 2023;72(suppl 1):28–35. DOI: 10.1007/s00101-023-01264-6
  10. Kumar AJ, Jones LE, Kollmeyer KR, et al. Radial artery access for peripheral endovascular procedures. J Vasc Surg 2017;66(3):820–825. DOI: 10.1016/j.jvs.2017.03.430
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.