Adenosine & Defib...

[ERRNTraveler, RN]

Just wondering, at your facility, is it protocol to get the pt. hooked up to the defib before giving Adenosine, or do you just have them on the cardiac monitor? I don't routinely hook the pt. up to the defibrillator before giving Adenosine, I just make sure they are on the monitor & that a crash cart is available should I need it, but a new Dr. in the ED questioned me last night about why I didn't have the pt. hooked up to the defib. Just curious as to what is considered routine at your facilities.

[UM Review RN, ASN, RN]

Not an ER nurse here, but I would ask myself if hooking the patient up would save a step later when time was of the essence.

If it's not needed, fine, no harm, right?

[vamedic4, EMT-P]

We don't routinely hook them to the defibrillator, but we do hook them to the monitor so that we can see exactly what's happening. I've yet to see them have to cardiovert a child - with our kids the ice or the adenosine always work.

vamedic4

glad last night's over

[RunnerRN, BSN, RN]

We also just have the defib at the bedside. Might be a smart idea to save a few seconds....but those pads are pretty expensive too.

[AnnieOaklyRN, BSN, RN, EMT-P]

hi,

I have never hooked a person up to a defib when giving adensoine, nor do I feel there is a need to. The only exception I woudl make is if you have a patient with WPW, high suspicion for Dig toxicity, or they have a REALLY sick heart, but other than that there is no real need unless it is your hospitals policy.

In most cases where a patient has been given adenosine and has had fatal arrythmias, which is very uncommon, it has been because they were given the drug innapropriatly either for a-fib or flutter which as you know is refracotry to adenosine because it works at the AV-node temporarily, just long enough to stop a reentrant pathway and not in the atria.

As long as you do not follow the theory that adenosine can be used as a diagnostic tool to differentiate between fib/flutter or reentrant SVT then the chances of having a mishap are very unlikely, and even after seeing it used inappropriatly for this reason I have never seen a patient convert into v-fib or v-tach.

Swtooth EMT-P, RN

[Dixielee, BSN, RN]

I have given quite a bit of adenosine over the years and have never hooked them to the defib in advance....cardiac monitor, yes, O2, crash cart closeby, solid IV access, yes, but no defib. I have never seen it induce a fatal arrhythmia. I have seen it not work on rare occasions, but have found it to be a great drug for SVT.

[Altra, BSN, RN]

We do not automatically put the defib pads on, but I do move the crash cart into the patient's room. Solid IV access, as someone else said, too.

[jojotoo, RN]

Never hooked up to defib, never needed it.

[Christie RN2006]

In the ICU our patients are already on a monitor, and everyone so far I have given Adenosine to had central lines. I always make sure the crash cart is in the room,I have saline going and if the patient is very unstable I will go ahead and connect them to the defibrillator. I am yet to see it convert a rhythm, I have seen it slow the rhythm down enough that we could see what it was.

[JBudd, MSN]

We've always just used the monitor, but we are in the trauma rooms with defib available anyway. Like Runner said, those defib pads are expensive.

[ER/ONCRN]

i have given adenosine plenty of times and have never attached defib but always had it handy jic. if a pt is severe enough to need adenosine, they should already be on a monitor, bp machine and o2! :)

[Diary/Dairy, RN]

The hospital I worked at previously it was their policy to attach the patient to the defib cart before administering adneosine. Another hospital I worked at (a teaching hospital) the policy was to have a cardiologist in the room before administering adenosine, as well as heart monitoring.