Nitro spray on skin before IV

[Moshi]

I was talking to a colleague of mine who said he knows someone who uses Nitrolingual spray on skin before applying IV needle on patients with small/hidden/bad veins.

Theoretically it seems plausible but has anyone ever tried that? What do you think? Does it work?

 

[Tigger]

I was told by my IV instructor that this trick doesn't work very well and just wastes another medication.

 

[Moshi]

OK, so it doesn't work very well. But it does work a bit? Isn't that still better than nothing when you can't find a vein?

 

[the_negro_puppy]

I've never tried it, but you would want to be very careful using a medication for a purpose other than what it was designed for. From what I read on here EMS workers in the US get fired over trivial things, these seems like one of those

 

[NYMedic828]

Don't know if it works, don't know if it would work and I'm not going to try and find out.

If I can't find a vein, there's plenty of other tricks I would try first that can't get me jammed up.

 

[Veneficus]

OK, so it doesn't work very well. But it does work a bit? Isn't that still better than nothing when you can't find a vein?

It is not better than nothing.

Somebody who knows anatomy, including common variations, well enough to apply such knowledge as to where the vein is likely to be not only more effective whether they can see the vein or not, but also have no use for such nonsense.

Because of embyological development of the upper limb in humans, the cephalic and basilic veins have very little deviation in most people.

I have found it really helps a lot to understand where they can be found, even if they cannot be seen.

 

[systemet]

I was talking to a colleague of mine who said he knows someone who uses Nitrolingual spray on skin before applying IV needle on patients with small/hidden/bad veins.

Theoretically it seems plausible but has anyone ever tried that? What do you think? Does it work?

This is a nitropatch. This particular nitropatch gives 0.4 mg / hr transdermally.

And you have a patient, with poor venous access, and you're planning on spraying 0.4mg of nitroglycerin on their hand / forearm?

I hope the patient doesn't have poor vascular access because they're hypotensive.

 

[fast65]

I've never heard of this trick before, and I'm certainly not willing to try it. Like Vene said, it's better to have a thorough understanding of the anatomy, than it is to rely on some folk trick, especially a folk trick that involves giving a medication to someone that doesn't need it.

 

[Medic Tim]

Ppl seriously do this? I am constantly amazed at the half assed tricks people come up with that really don't work. If they put that time into some constructive like education, ems would be in a much better place than it currently is in the us.

 

[Moshi]

Okay seems like noone here likes it. I was also a bit shocked when I first heard it. Didn't know what to think of it. Now I believe it's not right even as a last resort.

 

[Veneficus]

I've never heard of this trick before, and I'm certainly not willing to try it. Like Vene said, it's better to have a thorough understanding of the anatomy, than it is to rely on some folk trick, especially a folk trick that involves giving a medication to someone that doesn't need it.

Giving medication to somebody who doesn't need it is not a folk trick, it is a medication error.

Thought I would point that out.

 

[TransportJockey]

I'd never heard it until now... told my coworkers about it and none of us thought it was a good idea at all.

 

[RustyShackleford]

Your co-workers obviously have enough common sense to figure out the farce that this so called "trick" is.

 

[bigbaldguy]

I've heard of it but mostly along the lines of "back in the day we used to" kind of thing. Sounds like in theory it would work as far as the vein goes but as others have mentioned side effects could make the whole thing a very bad idea. If you really can't get access and access is critical now we have alternatives like EZIO so I think this is one of those things that is going to probably say a "back in the day" kind of thing.

 

[MedicBender]

I've heard of it but mostly along the lines of "back in the day we used to" kind of thing

That's my thought as well.

I asked around at work and the only medic who had heard of it was a guy that's been a medic for 25 years.

 

[LondonMedic]

I hope the patient doesn't have poor vascular access because they're hypotensive.

It is not going to be absorbed into the vein and passed around the peripheral circulation until it reaches the central circulation where it then causes massive horrific vasodilatation.

 

[Akulahawk]

I've heard of it but mostly along the lines of "back in the day we used to" kind of thing. Sounds like in theory it would work as far as the vein goes but as others have mentioned side effects could make the whole thing a very bad idea. If you really can't get access and access is critical now we have alternatives like EZIO so I think this is one of those things that is going to probably say a "back in the day" kind of thing.

I have heard of this as well. I personally have never tried it nor have anyone that I know of tried it in my presence. If I have trouble getting a vein to pop up using a traditional TK, I use a BP cuff manually inflated to just about the DBP. If the veins don't get seriously engorged with blood and you still can't feel them, something is wrong. Seriously wrong. I much prefer the regular little rubber (latex or non-latex) tourniquets over the BP cuff, partly because they're easier/faster to remove and they're cheap & disposable.

Oh, and +1 to Vene: using NTG (or GTN) spray in that manner is contrary to labeling and how we're supposed to administer it. Therefore, doing so is a med error.

 

[NYMedic828]

If the situation is so bad that you need to get an IV on the patient and would even consider something as silly as this, just go to the damn hospital.

I never understood people who will putz around on-scene for an extra 10 minutes making someone a pin cushion when they could be halfway to an ER.

A few minutes fine, 1 or two attempts sure. But some people go WAY overboard.

 

[jroyster06]

I think the nitro spray is a bit much. I have seen a couple of old school medics use a very very SMALL amount of nitro paste on the area they are looking at, about the size of a ball point pen. Not enough to cause any pressure drop but just enough to get the vein to pop up. I know what yall are going to say and i will be chastised but i will say from what I have seen.. It works.

I was just talking about this to another medic around here a couple weeks ago. He said he agrees it works and Hospitals have used local nitro paste in area's such as a brown recluse bite to dilate the veins because apparently that is where the necrosis comes from is vaso constriction but i havent researched enough of the patho of a brown recluse bite to know for sure.

 

[gordonfreeman]

Why not just go the IO route?