Adenosine & Defib...

[ERRNTraveler]

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.

[jojotoo, RN]

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.

I'm estimating 60% -70% conversion rate from SVT to NSR that I've seen in the ER. Once converted (or slowed) we usually watch the patient for a couple of hours, then discharge home. I've never seen an ER physician intentionally use adenosine to differentiate between SVT and a rapid A-fib or A-flutter.

So as far as not seeing SVT convert in the ICU, I'm wondering if maybe you're getting the more pathological arrhythmias.

One question though. When using a central line, are you able to push and flush adenosine as fast as is required?

[jojotoo, 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.

A cardiologist in the room!!!! What a luxury that would be. From the time the patient first presents to the ER until the time we give adenosine is usually less than 15 minutes.

[Diary/Dairy, RN]

A cardiologist in the room!!!! What a luxury that would be. From the time the patient first presents to the ER until the time we give adenosine is usually less than 15 minutes.

Well, we were a floor among other things, and so it was felt that we needed backup.; Also we were a teaching hospital, so sometimes, we just had the interns there to help out.

[neneRN, BSN, RN]

No, I don't place the pads on, just put them on the monitor. We only give Adenosine in our critical care rooms though, where there's a code cart right next to the stretcher. Usually leave them hooked up to the 12 lead too, so just have to push a button to get the repeat EKG without having to hook them up all over again.

[Christie RN2006]

I'm estimating 60% -70% conversion rate from SVT to NSR that I've seen in the ER. Once converted (or slowed) we usually watch the patient for a couple of hours, then discharge home. I've never seen an ER physician intentionally use adenosine to differentiate between SVT and a rapid A-fib or A-flutter.

So as far as not seeing SVT convert in the ICU, I'm wondering if maybe you're getting the more pathological arrhythmias.

One question though. When using a central line, are you able to push and flush adenosine as fast as is required?

With a central line you have the adenosine and a flush in the same line and you push the adenosine and then push the flush as fast as you possibly can. It is fine being pushed through a central line...

Lately our docs have been chicken about giving more than one dose... we do the first dose and we all stand around watching the monitor just waiting... I have pushed it twice here lately, the first time we slowed the rate from the 180s to the 100s, the second time was just last week and it slowed the rate from 224 to 150s then it went right back up. I personally think the second lady went into A. Fib with RVR, I don't think it was SVT. She ended up getting an amiodarone bolus and drip and got 4 doses of digoxin before the rate finally slowed. I wasn't there when it slowed, but when I came in that night it sure looked like A. Fib on the monitor to me! I think the doc was chicken about giving a second dose because this lady was a DNRCCA

[ZippyGBR, BSN, RN]

general UK practice in the ED - adenosine only given in resus areas

monitored via defib monitoring cable and 12 lead ecg

generally will also have spo2 and niBP from the monitor ( and if the leads haven't been lost defib linked to monitor)

when it;s given on the assessment unit - crash trolley moved to by the patient and the patient is monitored via the defib

there's no needs to put hands off pads on the patient - just monitor them with the monitoring leads

[ZippyGBR, BSN, RN]

A cardiologist in the room!!!! What a luxury that would be. From the time the patient first presents to the ER until the time we give adenosine is usually less than 15 minutes.

a little bit of overkill , certainly where i 've worked in ED and assessment settings the middle grade or staff specialist/ consultant (generally ED seniors in the ED) needs to be present even if a junior is giving the adenosine

[CritterLover, BSN, RN]

one question though. when using a central line, are you able to push and flush adenosine as fast as is required?

????

a central line is the ideal way to give adenosine.

the drug doesn't get metobolized while it is traveling through the central line tubing; when it hits the blood stream, it is right in front of the heart, where it needs to be to work. it doesn't need to travel through the venous system to reach the heart, risking being metabolized to inactive along the way.

[AnnieOaklyRN, BSN, RN, EMT-P]

I beleive too that you are suppose to cut the dose to 3mg, 6 mg, and 6mg when giving it thruogh a central line.

Also learned a new vagel meneuver from one of our er docs. Have the patient hold breath while trying to lift both legs of teh stretcher. This actaully seems to be much more effective than vasalva.

Swtooth

[EricJRN, MSN, RN]

That's a neat trick, swtooth!