Nitroglycerine Ointment as an Aid to Venepuncture

Hecker, J. F.; Lewis, G. B. H.; Stanley, Helen

doi:10.1016/s0140-6736(83)91631-8

Cited by 33 publications

(10 citation statements)

References 4 publications

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“…Organic nitrates have been shown to reverse the e ect of the two main sympathetic mediators of vasoconstriction, norepinephrine [2] and neuropeptide Y [16], making them suitable candidates for venous relaxation under these conditions. Several controlled and uncontrolled trials with different formulations of nitroglycerine have consistently shown that topical nitroglycerine may relax super®cial veins when measured with subjective scores [5,6,7,8] or when ease [5,6,8,9,10] or success of venepuncture were assessed [6]. The vasodilator e ect is expressed as percentage of the di erence of vein diameter before drug administration (set as 100% relaxation) minus diameter during preconstriction with phenylephrine (set as 0%).…”

Section: Discussionmentioning

confidence: 99%

“…The dilator e ect of ISDN was signi®cantly di erent from the e ect of placebo ointment (analysis of variance, P=0.05). As a control, infusion of nitroglycerine (GTN) into the preconstricted hand vein markedly relaxed the veins in both groups Thus far, nitroglycerine is the only organic nitrate studied in this regard and its e ects have been evaluated 15 [4], 20 [6,10], 60 [7,8,9] and 120 min [5] after local application of ointments or tape. Whenever and however measured, the e ects were highly variable and the optimum time for nitroglycerine application before venepuncture has not been established.…”

Section: Discussionmentioning

confidence: 99%

“…Nitroglycerine e ciently reverses a-adrenergic venoconstriction [2,3] by activation of the nitric oxide±cyclic guanosine monophosphate (NO-cGMP) cascade, a pathway which opposes a-adrenergic e ects under physiological conditions. However, non-responders were frequent [4], the optimum timing with respect to nitrate application has not been established [4,5,6,7,8,9,10] and the extent of venodilation has not been thoroughly investigated. The aim of this study was therefore to quantify venous relaxation over time using a double-blind, placebo-controlled design.…”

Section: Introductionmentioning

confidence: 99%

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Local effect of transdermal isosorbide dinitrate ointment on hand vein diameter

Khanlari

Linder

Haefeli

2001

Eur J Clin Pharmacol

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Objective: To assess the e ect of topically applied isosorbide dinitrate (ISDN) ointment on super®cial hand veins preconstricted with phenylephrine. Methods: Using the hand vein compliance technique, venous diameter changes were measured in a doubleblind, randomised, placebo-controlled cross-over trial in 12 healthy volunteers. During preconstriction with phenylephrine, placebo or ISDN ointment was administered to assess the dilator e ect of transdermal ISDN. Finally a single i.v. dose of nitroglycerine was administered into the hand vein to assess the maximal venous response to organic nitrovasodilators. Results: ISDN ointment (equivalent to 13.4 3.61 mg ISDN) caused a signi®cant dilator e ect of 39.1 21.7% (mean SEM, P=0.02) which reached its maximum after 42.5 16.6 min. Maximum ISDN e ects were inversely correlated with venous baseline diameter (r 2 =0.38, P=0.03) and independent of the amount of ointment applied or the extent of preconstriction (P>0.3). Conclusion: Similar to nitroglycerine, topical ISDN may relax super®cial hand veins within 60 min after application, suggesting that it might ease venepuncture particularly of small vessels. The large variability of the e ect and the time to reach the e ect, however, restrict its practical usefulness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Local effect of transdermal isosorbide dinitrate ointment on hand vein diameter

Khanlari

Linder

Haefeli

2001

Eur J Clin Pharmacol

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“…8 -10 Increased blood flow due to nitroglycerine application may be due to direct arterial and venous dilatation overcoming vasospasm and allowing flow around microthrombi or opening up of collateral circulation to the affected areas. 2,8 Indeed, topical nitroglycerine has been shown to induce venous dilatation to facilitate venous cannulation in adults 13 and children. 14 Common adverse effects of nitroglycerine include headache and dizziness in adults although serious side effects are rare.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Topical Nitroglycerine in Ischaemia Associated With Umbilical Arterial Line in a Neonate

Varughese

Koh

2001

J Perinatol

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“…When used topically, nitroglycerine ointment (NGO) produces local vasodilatation and has been used in adults and children to facilitate venipuncture or intravenous cannulation. 10,11 In small amounts, its systemic absorption is insignificant and side effects such as hypotension and methemoglobinemia can be avoided. We designed this study to determine if topical NGO would safely reduce the collection time and associated pain/distress with heelstick blood collection for routine newborn metabolic screening.…”

Section: Introductionmentioning

confidence: 99%

Can Nitroglycerine Ointment Facilitate Newborn Heelstick Blood Collection? A Randomized Controlled Trial

2003

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Newborn heelstick blood collection can be a painful procedure in part because of the time required to obtain sufficient quantity of blood. No previous studies have determined whether local vasodilatation using topical nitroglycerine ointment (NGO) would facilitate heelstick blood collection. OBJECTIVE:To determine if the topical application of NGO would reduce the time needed to collect the required amount of blood for newborn metabolic screening and, in turn, reduce the pain/distress of the procedure. STUDY DESIGN:In a randomized, prospective, placebo controlled and blinded fashion, term newborns in a well nursery received either topical nitroglycerine or placebo ointment 10 minutes prior to heelstick. Total time and number of heelsticks required to complete the collection were measured along with crying time, heart rate and blood pressure. RESULTS:In all, 50 were studied, 25 in each group. There was no statistical difference between groups in collection time, crying time or number of heelsticks required for completion. Heart rate increased significantly and equally in both groups. Blood pressures were unchanged. CONCLUSIONS:Topical NGO did not facilitate heelstick blood collection or reduce the pain/distress of the procedure.

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Nitroglycerine Ointment as an Aid to Venepuncture

Cited by 33 publications

References 4 publications

Local effect of transdermal isosorbide dinitrate ointment on hand vein diameter

Local effect of transdermal isosorbide dinitrate ointment on hand vein diameter

Successful Use of Topical Nitroglycerine in Ischaemia Associated With Umbilical Arterial Line in a Neonate

Can Nitroglycerine Ointment Facilitate Newborn Heelstick Blood Collection? A Randomized Controlled Trial

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