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. 1991 Feb;84(2):69–72. doi: 10.1177/014107689108400205

Transdermal glyceryl trinitrate to allow peripheral total parenteral nutrition: a double-blind placebo controlled feasibility study.

H T Khawaja 1, J D Williams 1, P C Weaver 1
PMCID: PMC1293089  PMID: 1900335

Abstract

Seventy-two consecutive patients requiring total parenteral nutrition (TPN) were randomized to two groups. Group A received daily a peripheral intravenous regimen which provided 10 g nitrogen and 1400 non-nitrogen kcal (5.9 MJ). Group B received daily a peripheral intravenous regimen which delivered 9.4 g nitrogen and 1900 non-nitrogen kcal (8.0 MJ). Each group was further randomized to receive a self-adhesive patch of transdermal glyceryl trinitrate (GTN) or an identical placebo. Infusion survival was the main end-point. For group A, the median time of infusion survival was 74 h (range: 58-100) in the control group compared with 108 h (range: 68-156) in the group that received transdermal GTN (P less than 0.001). For group B, the median infusion survival was 67 h (range: 46-92) in the control group compared with 103 h (range: 66-151) in the treatment group (P less than 0.001). TPN is feasible via peripheral veins and the incidence of infusion failure can be effectively reduced by transdermal GTN.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Askanazi J., Carpentier Y. A., Elwyn D. H., Nordenström J., Jeevanandam M., Rosenbaum S. H., Gump F. E., Kinney J. M. Influence of total parenteral nutrition on fuel utilization in injury and sepsis. Ann Surg. 1980 Jan;191(1):40–46. doi: 10.1097/00000658-198001000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blackburn G. L., Flatt J. P., Clowes G. H., O'Donnell T. E. Peripheral intravenous feeding with isotonic amino acid solutions. Am J Surg. 1973 Apr;125(4):447–454. doi: 10.1016/0002-9610(73)90080-9. [DOI] [PubMed] [Google Scholar]
  3. Elwyn D. H., Kinney J. M., Askanazi J. Energy expenditure in surgical patients. Surg Clin North Am. 1981 Jun;61(3):545–556. doi: 10.1016/s0039-6109(16)42436-9. [DOI] [PubMed] [Google Scholar]
  4. Franks A. G., Jr Topical glyceryl trinitrate as adjunctive treatment in Raynaud's disease. Lancet. 1982 Jan 9;1(8263):76–77. doi: 10.1016/s0140-6736(82)90215-x. [DOI] [PubMed] [Google Scholar]
  5. Fujiwara T., Kawarasaki H., Fonkalsrud E. W. Reduction of postinfusion venous endothelial injury with intralipid. Surg Gynecol Obstet. 1984 Jan;158(1):57–65. [PubMed] [Google Scholar]
  6. Gran L., Bleie H., Jeppson R., Maartmann-Moe H. Etomidat mit Intralipid. Eine Lösung zur schmerzfreien Injektion. Anaesthesist. 1983 Oct;32(10):475–477. [PubMed] [Google Scholar]
  7. Greenberg G. R., Marliss E. B., Anderson G. H., Langer B., Spence W., Tovee E. B., Jeejeebhoy K. N. Protein-sparing therapy in postoperative patients. Effects of added hypocaloric glucose or lipid. N Engl J Med. 1976 Jun 24;294(26):1411–1416. doi: 10.1056/NEJM197606242942601. [DOI] [PubMed] [Google Scholar]
  8. Hecker J. F., Fisk G. C., Lewis G. B. Phlebitis and extravasation ("tissuing") with intravenous infusions. Med J Aust. 1984 May 26;140(11):658–660. doi: 10.5694/j.1326-5377.1984.tb108292.x. [DOI] [PubMed] [Google Scholar]
  9. Hecker J. F., Lewis G. B., Stanley H. Nitroglycerine ointment as an aid to venepuncture. Lancet. 1983 Feb 12;1(8320):332–333. doi: 10.1016/s0140-6736(83)91631-8. [DOI] [PubMed] [Google Scholar]
  10. Jackson J. M., Khawaja H. T., Talbot S. T., Lee H. A. The effect of surgery and nutritional regimen on plasma lipoproteins and fat metabolites in man. Clin Nutr. 1990 Feb;9(1):1–7. doi: 10.1016/0261-5614(90)90066-2. [DOI] [PubMed] [Google Scholar]
  11. Khawaja H. T., Campbell M. J., Weaver P. C. Effect of transdermal glyceryl trinitrate on the survival of peripheral intravenous infusions: a double-blind prospective clinical study. Br J Surg. 1988 Dec;75(12):1212–1215. doi: 10.1002/bjs.1800751223. [DOI] [PubMed] [Google Scholar]
  12. MacFie J. Active metabolic expenditure of gastroenterological surgical patients receiving intravenous nutrition. JPEN J Parenter Enteral Nutr. 1984 Jul-Aug;8(4):371–376. doi: 10.1177/0148607184008004371. [DOI] [PubMed] [Google Scholar]
  13. Makarewicz P. A., Freeman J. B., Fairfull-Smith R. Prevention of superficial phlebitis during peripheral parenteral nutrition. Am J Surg. 1986 Jan;151(1):126–129. doi: 10.1016/0002-9610(86)90022-x. [DOI] [PubMed] [Google Scholar]
  14. Mason D. T., Braunwald E. The effects of nitroglycerin and amyl nitrite on arteriolar and venous tone in the human forearm. Circulation. 1965 Nov;32(5):755–766. doi: 10.1161/01.cir.32.5.755. [DOI] [PubMed] [Google Scholar]
  15. Mattila M. A., Rossi M. L., Ruoppi M. K., Korhonen M., Larni H. M., Kortelainen S. Reduction of venous sequelae of i.v. diazepam with a fat emulsion as solvent. Br J Anaesth. 1981 Dec;53(12):1265–1268. doi: 10.1093/bja/53.12.1265. [DOI] [PubMed] [Google Scholar]
  16. Mughal M. M. Complications of intravenous feeding catheters. Br J Surg. 1989 Jan;76(1):15–21. doi: 10.1002/bjs.1800760107. [DOI] [PubMed] [Google Scholar]
  17. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Pineault M., Chessex P., Piedboeuf B., Bisaillon S. Beneficial effect of coinfusing a lipid emulsion on venous patency. JPEN J Parenter Enteral Nutr. 1989 Nov-Dec;13(6):637–640. doi: 10.1177/0148607189013006637. [DOI] [PubMed] [Google Scholar]
  19. Rattenbury J. M., Timmins J. G., Cawthorne E. A., Ganapathy S., Taylor C. J. Identification of the cause of separation (creaming) of lipid emulsions in intravenous infusion. J Pediatr Gastroenterol Nutr. 1989 May;8(4):491–495. doi: 10.1097/00005176-198905000-00012. [DOI] [PubMed] [Google Scholar]
  20. Wilson A., Goode A. W., Kirk C. J., Sugden M. Parenteral nutrition via peripheral veins: a feasibility study. J R Soc Med. 1987 Jul;80(7):430–433. doi: 10.1177/014107688708000712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Wright A., Hecker J. F., Lewis G. B. Use of transdermal glyceryl trinitrate to reduce failure of intravenous infusion due to phlebitis and extravasation. Lancet. 1985 Nov 23;2(8465):1148–1150. doi: 10.1016/s0140-6736(85)92678-9. [DOI] [PubMed] [Google Scholar]

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