Randomized clinical trials to determine the role of topical glyceryl trinitrate in peripheral intravenous nutrition.
BACKGROUND
The contribution of glyceryl trinitrate (GTN) to prevention of peripheral vein thrombophlebitis (PVT) during peripheral intravenous nutrition delivered by fine-bore midline intravenous catheter is unclear. The aim of this study was to establish its role.


METHODS
Two consecutive randomized clinical trials were conducted. In trial 1 patients were randomized to receive standard peripheral intravenous nutrition containing heparin and hydrocortisone with or without the placement of a topical GTN patch (triple therapy or dual therapy). In trial 2 patients were randomized to receive standard peripheral intravenous nutrition with either dual therapy or topical GTN alone (monotherapy).


RESULTS
Dual therapy was as effective as triple therapy in preventing PVT (incidence 10 of 37 versus 11 of 39 patients respectively). Dual therapy reduced the incidence and increased the time to onset of PVT compared with monotherapy (14 of 41 versus 22 of 35 patients respectively, P = 0.012; median 17.3 (95 per cent confidence interval (c.i.) 13.4 to 21.1) versus 8.9 (95 per cent c.i. 6.7 to 11.0) days, P = 0.007).


CONCLUSIONS
Use of a topical GTN patch confers no benefit when peripheral intravenous nutrition is delivered via a fine-bore midline intravenous catheter.
Dobbins
B M
BM
Academic Unit of Surgery, The General Infirmary at Leeds, Leeds, UK. brian.dobbins@cht.nhs.uk
Catton
J A
JA
Tighe
M J
MJ
Miller
G V
GV
Martin
I G
IG
McMahon
M J
MJ
D000287:Administration, Topical; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D002406:Catheterization, Peripheral / Q000379:methods; D004359:Drug Therapy, Combination; D005248:Feeding Methods; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D011140:Polyurethanes; D013924:Thrombophlebitis / Q000517:prevention & control*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D011140:Polyurethanes; D014665:Vasodilator Agents; D006493:Heparin; D005996:Nitroglycerin; D006854:Hydrocortisone