Digital Ischemia: Guidance for Administration of Nitroglycerin 2% Ointment
| Target site of application: Healthy tissue bordering the line of demarcation of all digits identified as having concerns of diagnosis of ischemia; optimally 5-10 mm (roughly ¼ inch) from the demarcation line to ensure adequate absorption by the healthy tissue and best chance of improved perfusion to the area of ischemia. Prepare the site of application: Prior to applying, gently wipe away any remaining ointment from previous applications or other topicals from the planned site of application. Application: Wearing gloves, apply a thin layer of nitroglycerin ointment to the healthy tissue bordering the line of demarcation for all affected digits. Avoid massaging the area or driving the ointment deep into the skin to prevent excessive systemic absorption. If patient movement/mobility may risk ointment from staying in place at the targeted application site, a Tegaderm may be placed over the ointment after application to keep ointment in place and to prevent spread to unintended areas. Re-application: When it is time to reapply, remove Tegaderm (if applicable) and gently wipe away any remaining ointment from previous application to ensure newly applied ointment will have good and direct contact with healthy tissue. The line of demarcation may change as perfusion improves or ischemia worsens. With each new application, the target site of application should also shift to continue optimal application to the healthy tissue 5-10 mm from the line of demarcation at the time of each new application. |
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.