The proposal was to use a 1/2 inch of Nitropaste over or slightly distal to the insertion site of a basilic vein to dilate it so that the venipuncture and entire threading procedure would be easier in a vessel. Not for small diameter veins but to increase a 5-6mm vein so that vein wall damages are minimized with threading. Possibly decreasing initial trauma and provide preventative strategy for later DVT complications. Certainly screening patients with low B/P issues would negate this practice as NP may further drive systemic vasodilation in an unpleasant direction.
Is any one using Nitropaste either PRN or routinely under an approved Medical Protocol (via your Medical Director) for the above reasoning. I have heard of this practice performed during PICC insertions and would like some "pro and con" comments - if it is still being used....even occassionally.
Thanks very much!
Scott Gilbert, RN, CRNI, VA-BC
Hawaii
I was first asked and refused to use this approach in 1983 when it was suggested in a basic nursing journal. My concerns have not changed - this is a medication prescribed for cardiac problems.
Well yes vessel dilation results.... what are you going to tell the patient, the doctor to prescribe it and what do you do if the patient has a vagal type reaction.
How would you predict how the patient would repsond, what age patients are you thinking this would be appropriate for?
Ann
Ann Zonderman, BSN, JD, CRNI
Is there a problem you are trying to correct? DVT incidence high? Hematomas post insertion? I guess it's hard to comment without knowing why the proposal to begin with. A 5-6mm vessel is more than twice the diameter of a 6 Fr. PICC and even beginners should be able to cannulate with minimal trauma. I feel you would get more assistance if you shared the problem that spawned the proposal, as I feel there are probably better solutions than nitro.
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Scott, there are a few studies of using NTG transdermally to access superficial veins for insertion of PIV. I do not recall anything about using it for PICC insertion. My concern would be that the depth of the basilic vein would not allow for any great change in diameter, and also that the length of the vein dilated would not be sufficient to make any difference when advancing a PICC due to its length. I am not aware of anyone using NTG for PICCs. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861