UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Effect of Administration Set on Nitroglycerin Infusion

Keywords: nitroglycerin, administration set, drug sorption, PVC tubing, polyethylene, SCAPE (PubMed Search)

Posted: 6/8/2023 by Matthew Poremba (Updated: 4/24/2024)
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Nitroglycerin easily migrates into polyvinyl chloride (PVC), a plastic commonly used in intravenous tubing due to its flexibility and low cost. A slow rate of flow and long tubing length increase the loss of nitroglycerin. While using less absorptive tubing (i.e. polyethylene or polypropylene) when administering nitroglycerin is recommended, most published clinical studies looking at nitroglycerin have used PVC tubing.

 

A 1989 study compared nitroglycerin delivery through PVC tubing and low sorbing tubing at various concentrations and flow rates.1 Samples were obtained from the nitroglycerin bottle and the distal end of the tubing at several time points. 

  • An average of 39.7% (SD 12.7) of nitroglycerin was lost at the distal end of PVC tubing, while an average of 2.3% (SD 9.3) of nitroglycerin was lost with low sorbing tubing.

A 2018 study enrolled 8 volunteers to receive nitroglycerin infusions through PVC tubing and low sorbing polyolefin tubing.2 

  • The average max plasma concentration of nitroglycerin was 0.33 ng/ml (SD 0.19) in the PVC group, compared to 1.37 ng/ml (SD 0.89) with low sorbing tubing. 
  • This small study showed a trend towards greater lowering of mean arterial pressure from baseline with low sorbing tubing when compared to the PVC group, although this was not statistically significant.

 

Bottom Line: Most studies evaluating nitroglycerin use in various clinical scenarios have used PVC tubing. Doses based on use with PVC tubing may be too high when using less absorptive tubing. Employing more conservative dosing strategies when using low sorbing tubing can help mitigate the risk of adverse effects (i.e. hypotension, headache).

References

  1. Tracy TS, Bowman L, Black CD. Nitroglycerin delivery through a polyethylene-lined intravenous administration set. Am J Hosp Pharm. 1989 Oct;46(10):2031-5. PMID: 2510512.
  2. Kim CO, Song J, Min JY, Park SJ, Lee HM, Byon HJ. A comparison of the pharmacokinetic and pharmacodynamic properties of nitroglycerin according to the composition of the administration set: A preliminary study. Medicine (Baltimore). 2018 Mar;97(9):e9829. doi: 10.1097/MD.0000000000009829. PMID: 29489681; PMCID: PMC5851736.
  3. Nitroglycerin [package insert]. Shirley, NY: American Reagent. 11/2005