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Paediatric Emergency Medicine
Local nitroglycerin to facilitate peripheral arterial cannulation in children: systematic review and meta-analysis
  1. Deepika Wagh1,2,
  2. Dinesh Pawale1,3,
  3. Jason Khay Ghim Tan2,4,
  4. Shripada C Rao1,2
  1. 1 Neonatology, Perth Children's Hospital Neonatal Clinical Care Unit, Nedlands, Western Australia, Australia
  2. 2 Paediatrics, The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
  3. 3 Neonatology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
  4. 4 Neonatology, Perth Children's Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Deepika Wagh, Neonatology, Perth Children's Hospital Neonatal Clinical Care Unit, Nedlands, WA 6009, Australia; deepika.wagh{at}health.wa.gov.au

Abstract

Background Neonates and children admitted to intensive care units require peripheral arterial cannulation to monitor their blood pressures and for blood sampling, but many times it is unsuccessful.

Objective To conduct a systematic review and meta-analysis to evaluate the efficacy and safety of local nitroglycerin (NTG) to facilitate peripheral artery cannulation in neonates and children.

Review methods PubMed, EMBASE, CINAHL, Emcare and Cochrane library were searched till August 2021. Grey literature was searched through Mednar. Data were extracted by two reviewers independently using a prespecified form and the risk of bias was assessed. Meta-analysis was conducted using a random-effects model. The I2 statistic was used to quantify statistical heterogeneity. Certainty of evidence was assessed using the criteria of inconsistency, imprecision, indirectness, publication bias and size of effect as per the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines.

Results Two randomised controlled trials (RCTs) were included in this meta-analysis (n=153). One was conducted in children 2–8 years of age and the other was in children <2 years. Both trials found increased success rates with the use of local NTG. Pooling of the two studies found that the first-attempt success rate was significantly higher in the NTG group (risk difference: 0.44, 95% CI 0.05 to 0.83; I2=89%). Overall procedure time was significantly lower in the NTG group (mean difference: −100.28 s, 95% CI −136.74 to –63.82; I2=0%). No major complications secondary to the use of NTG were noted. The GRADE of evidence was very low.

Conclusion Local NTG may be useful in facilitating peripheral arterial cannulation in children. Adequately powered RCTs are needed to confirm these findings.

  • paediatrics
  • intensive care units, paediatric

Data availability statement

No data are available. Not applicable.

http://dx.doi.org/10.1136/archdischild-2021-323757

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    Data availability statement

    No data are available. Not applicable.

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    Footnotes

    • Contributors DW conceptualised and designed the study and data collection instruments, searched the literature, collected the data, drafted the initial manuscript and reviewed the manuscript. DW is the guarantor of the study. DP conceptualised and designed the study and data collection instruments, searched the literature, collected the data, drafted the initial manuscript and reviewed and revised the manuscript. JKGT searched the literature, collected the data, drafted the initial manuscript and reviewed and revised the manuscript. SCR coordinated and supervised the data collection, did the statistical analysis, interpreted the results and critically reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.