Local Nitroglycerin Application for Arterial Puncture

Evidence for Intra-arterial Nitroglycerin

• The American Heart Association recommends intra-arterial nitroglycerin (100-200 μg) after sheath insertion during transradial procedures to reduce radial artery spasm, though its short half-life necessitates coadministration with calcium channel blockers 1, 2
• Intra-arterial nitroglycerin can prevent vasospasm during catheter manipulation, which is especially useful during infusion of particulate embolic materials, with doses ≤100 μg per tumor-feeding artery considered safe 3

Critical Safety Considerations

• Nitroglycerin can cause significant hypotension and cardiovascular decompensation, particularly when combined with other vasodilators or in hypovolemic patients 4
• Avoid in patients with systolic blood pressure <90 mmHg, as vasodilators may reduce central organ perfusion 6, 7
• Exercise caution in patients with cardiogenic shock, severely reduced ejection fraction, or severe aortic stenosis 1, 2
• Do not use in patients who have taken phosphodiesterase inhibitors (sildenafil within 24 hours, tadalafil within 48 hours) 5
• Excessive nitroglycerin (>100 μg intra-arterially) may cause serious adverse events including hypotension 3

Common Pitfalls to Avoid

• Do not use prophylactically in hemodynamically unstable patients, as the venodilating effects can lead to cardiovascular decompensation through decreased preload 4
• Do not administer without considering intravascular volume status and hemodynamic effects of concurrent medications 4