Name:
Date of Birth: DD /MM /YYYY
MRN Number:
Glyceryl Trinitrate (GTN) NHS Number:
Infusion Chart for Chest Pain (or affix hospital label here)
Hospital: Ward:
1. Prescription
Please indicate in the inpatient drug chart that a Glyceryl Trinitrate Infusion Chart is being used. When pre-
scribing dosage please write ‘see GTN Chart’. Prescribing the infusion in this way authorises the designated
nurses to adjust the infusion rate according to response.
Doctor’s Name (Print): Doctor’s Signature: Date: Time:
DD /MM /YYYY
2. Infusion Solution
Prepare the infusion solution by drawing up a 50mL syringe of (ready mixed) Glyceryl Trinitrate (50mg in
50mL).
As with all infusion solutions any unused portion should be discarded after 24hours.
3. Administration of Infusion Solution
The initial infusion rate is 1mg (1mL) per hour.
Commence Infusion at Given By: Signature: Date: Time:
1mg (1mL) per hour DD /MM /YYYY
Observe the patient for the first 5 minutes to watch for signs of sensitivity (↓BP, pale, faint, dizzy, unwell,
EWS).
Dosage adjustment
In all cases the dose administered should be adjusted to patient response. Titrate to Pain Score (PS) 0-3.
Titrate infusion up or down at 0.5-1mL/hour increments in 15 minute intervals as tolerated by patient’s
BP and pain score. Always maintain systolic blood pressure above 90mmHg.
Pathway 1 Pathway 2 Pathway 3
PS 1, PS 2, PS 3,
Infuse GTN 1-3mL/hour Infuse GTN 3-5mL/hour Infuse GTN 5-10mL/hour
• Check BP – 30 minutes • Check BP – 30 minutes • Check BP – 30 minutes
• Systolic BP > 90 – Continue • Systolic BP > 90 – Continue • Systolic BP > 90 – Continue
• PS > 1 – Move up to Pathway 2 • PS > 2 – Move up to Pathway 3 • PS < 3 – Move down to
Pathway 2
• Pain Free – Titrate down and • PS < 2 – Titrate dose to
Stop Infusion Pathway 1 • Pain ↑ – Seek medical advice
• Systolic BP ↓ but > 90 – • Pain Free – Titrate down and • Systolic BP ↓ but > 90 –
Increase monitoring frequency Stop Infusion Increase monitoring frequency
to 15 minutes to 15 minutes
• Systolic BP ↓ but > 90 –
• Systolic BP < 90 – Titrate down Increase monitoring frequency • Systolic BP < 90 – Titrate down
and Stop Infusion to 15 minutes and Stop Infusion
• Systolic BP < 90 – Titrate down
and Stop Infusion
Administration of the infusion and titration of the dose must be documented overleaf
To be filed in the Charts and Forms Section of the Health Record GHNHSTFT/Y0800/08.10
Infusion Observations
Syringe Given By
Date Time Rate
Concentration BP Pain Score EWS Checked By
mL/hour
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
Glyceryl Trinitrate
50 mg per 50 mL
