Local nitroglycerin to facilitate radial arterial catheterization in adults: a systematic review and meta-analysis

We sought to investigate the efficacy and safety of local nitroglycerin (NTG) application in facilitating radial artery cannulation in adults.

In February 2024, we searched PubMed®, Embase, EMCARE, and the Cochrane Library. Local NTG could have been subcutaneous injection or topical application. We sought to conduct a meta-analysis using Hartung-Knapp adjustment of the DerSimonian-Laird random effects model.

We included 15 randomized controlled trials (RCTs) (n = 2,370), of which 4 (n = 423) evaluated topical NTG, whereas 11 (n = 1,947) used subcutaneous infiltration. All 4 trials evaluating topical NTG and 9/11 evaluating subcutaneous NTG used ultrasound to facilitate radial artery cannulation, whereas this was unclear in 2/11 trials evaluating subcutaneous NTG. The majority of studies had an unclear risk of bias (ROB). All 15 studies reported NTG to be beneficial. The meta-analysis found that subcutaneous NTG was associated with increased rates of first-attempt success (risk ratio [RR], 1.61; 95% confidence interval [CI], 1.23 to 2.10; five studies; 516 patients) and decreased risk of radial artery spasm (RR, 0.43; 95% CI, 0.24 to 0.77; seven studies; 1,519 patients). Topical NTG was associated with increased rates of first-attempt success (RR, 2.45; 95% CI, 1.39 to 4.34; one study; 92 patients) but resulted in little or no difference to the incidence of radial artery spasm (RR, 0.67; 95% CI, 0.20 to 2.25; three RCTs; 275 patients). The overall certainty of evidence was low.

Topical or subcutaneous NTG has the potential to facilitate radial artery access and decrease local complications. Given that the certainty of evidence was low, additional RCTs are needed.

PROSPERO ( CRD42022342158 ); first submitted 29 June 2022.