INDICATIONS
- Acute pulmonary oedema
- Uncontrolled pain of cardiac origin, including aortic dissection
- Accelerated hypertension with pulmonary oedema or acute coronary syndrome
PREPARATIONS
- GTN 1 mg/mL in 50 mL ampoule
SYRINGES AND TUBING
- Compatible syringes and tubing
- rigid plastic syringes (e.g. Gillette Sabre, Brunswick Disposable, BD Plastipak)
- polyethylene tubing (e.g. Vygon Lectrocath, David Bull Laboratories Types A261 or A2001)
- GTN is incompatible with
- polyvinylchloride (PVC) infusion bags (e.g. Steriflex, Boots, Viaflex, Travenol)
DOSAGE
Acute pulmonary oedema
- GTN by continuous IV infusion, initially 20 microgram/min
- decreasing to 10 microgram/min; or
- increasing in increments of 20 microgram/min at 15–30 min intervals
- until desired response or a maximum of 200 microgram/min is achieved
- Provided BP remains >90 mmHg systolic and >60 mmHg diastolic
Uncontrolled pain of cardiac origin
- GTN by continuous IV infusion, initially 10 microgram/min
- titrated upwards at 15 min intervals in increments of 5 or 10 microgram/min
- until desired response in pain control to a maximum of 200 microgram/min
- Provided BP remains >90 mmHg systolic and >60 mmHg diastolic
Accelerated hypertension
- If patient also has Acute pulmonary oedema or Uncontrolled pain of cardiac origin, follow appropriate dosage instructions as above
- Otherwise give GTN by continuous IV infusion, initially 5 microgram/min
- titrated upwards at 15 min intervals in increments of 5 or 10 microgram/min
- according to patient response to a maximum of 100 microgram/min
- See Accelerated (malignant) hypertension guideline
ADMINISTRATION
- Fill a compatible 50 mL syringe with GTN solution 1 mg/mL (50 mL)
- Administer via a syringe pump, and titrate pump rate according to patient response
50mL syringe of 1 mg/mL solution
Remember
- In acute pulmonary oedema, maximum rate is 200 microgram/min
- In uncontrolled pain of cardiac origin, maximum rate is 200 microgram/min
- In accelerated hypertension, maximum rate is 100 microgram/min
Pump rate for selected dose
Enter dose required (microgram/min):
© 2022 The Bedside Clinical Guidelines Partnership.
Created by University Hospital North Midlands and Keele University School of Computing and Mathematics.
Research and development team: James Mitchell, Ed de Quincey, Charles Pantin, Naveed Mustfa