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.
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.
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
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
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
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
Ruzsa Z, Szolnoky J. Radial artery cannulation: a systemic review. J Anesthe Clinic Res 2012;4(3). DOI: 10.4172/2155-6148.1000313
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
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
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/sj.jp.7210713
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
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