Effects of subcutaneously infiltrated nitroglycerin on diameter, palpability, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography

Abstract

Background: The success of transradial catheterization depends on meticulous access of radial artery which in turn depends on palpating a good radial pulse.

Objectives: Our objectives were to analyze the effects of subcutaneously infiltrated nitroglycerin on diameter of radial artery, palpability of radial pulse, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography.

Methods: Patients undergoing transradial coronary angiography were randomized to Group NL or Group SL. In Group NL, 3 ml of solution containing nitroglycerin and lignocaine was infiltrated subcutaneously at the site intended for puncture of radial artery. Similarly, saline and lignocaine were infiltrated in Group SL. Diameter of radial artery was objectively assessed by ultrasonography. Measurements were performed at baseline and repeated at 1 min after injecting the solutions. The ease-of-puncture was evaluated by the number of punctures and the time needed for successful access of radial artery.

Results: Both groups had 100 patients each. Baseline diameter of radial artery was similar between two groups. The post-injection diameter of radial artery increased by 26.3% in Group NL and 11.4% in Group SL. Nitroglycerin significantly improved the palpability of radial pulse, reduced the number of punctures and shortened the time needed for successful access of radial artery. Pre-cannulation spasm of radial artery occurred in 1% of Group NL and 8% of Group SL.

Conclusions: Subcutaneously infiltrated nitroglycerin leads to significant vasodilation of radial artery. This avoids pre-cannulation spasm of radial artery, enhances palpability of the radial pulse and thus makes the puncture of radial artery easier.

Keywords: Diameter of radial artery; Nitroglycerin; Palpability of radial pulse; Radial artery access; Spasm of radial artery.

Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Figures

Fig. 1

Assessment of diameter of radial artery: ultrasonographic image shows assessment of diameter of radial artery at peak of R wave in electrocardiogram using 9 MHz vascular probe.

Fig. 2

Comparison of diameter of radial artery: graph shows comparison of mean diameter of radial artery between Group NL and Group SL. Graph also shows comparison between baseline and 1 min post-injection values of mean diameter of radial artery in each group.