title: 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.
  
  
  OBJECTIVE
  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.
authors: Department of Cardiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India. Electronic address: drebabu@gmail.com.
authors: Babu
authors: B
authors: Ezhumalai
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors: Santhosh
authors: S
authors: Satheesh
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors: Balachander
authors: B
authors: Jayaraman
mesh_terms: D002404:Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D011292:Premedication; D011446:Prospective Studies; D011674:Pulse; D011677:Punctures; D017534:Radial Artery / Q000187:drug effects*; D014661:Vasoconstriction / Q000187:drug effects*; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: Diameter of radial artery; Nitroglycerin; Palpability of radial pulse; Radial artery access; Spasm of radial artery
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