adenosine for ER nurses

[sunshineonleith]

how do you give it? I have always worked with another rn (so they could add a fast flush in addition to the ns hanging wide open) and had the patient on the crash cart monitor. I like to have the doc at the bedside too.

Last night I saw someone give it for svt in a stable patient with a rate in the 180s with no fluids and all by himself. I came in when he yelled for help as her rate jumped to the 270s.

I am pretty conservative safety wise but it surprised me enough to wonder how others cardiovert (chemically). What do you do?

[jmgrn65, RN]

Usually a Doc needs to be present.

It has to be given very fast it has a very short half life like 15 seconds (not sure on that)

best if given in a vein closest to heart in the AC or central line, followed by a fast flush.

when it works it actually stops the heart and restarts in the patients baseline rhythm.

[emtb2rn, BSN, RN, EMT-B]

Where I am, it's given by a doc using a 3-way stopcock for an immediate NS flush. What you describe sounds ineffective not to mention dangerous.

[Pudnluv, ASN, RN]

Where I work it is always given by a an MD. It is given rapid IV push followed by NS flush. We always have the person hooked up to a bedside monitor also.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Where I work the RN gives it, pt on Lifepak, immediate flush. We give 6mg, then 12mg X 2 prn. Dr isn't always in the room, but hey, we can and often do, start codes without a doc! I actually can't recall ever needing to code someone after adenocard in the >10yrs I've been doing this. We do often end up shocking them because the adenocard didn't work however.

[mountainnurse]

Where I work we always have two nurses, MD at the bedside, crash cart at the bedside and in certain cases pads placed on the pt's chest. The adenosine is pushed rapidly into the closest port, ideally in an AC vein and immediately followed by a 20 ml NS flush and in addition running NS fluids and the pt's arm is lifted to facilitate delivery.

[sunshineonleith]

thanks for all the replies! In my facility Rns always do the push, but otherwise what you all describe is similar to what I am used to. I'm not crazy after all!

[twinmommy+2, ADN, BSN, MSN]

In my ER we have a person on the defibrillator pads, on the ekg connected continuously to get an ekg before and after conversion, IV at the most proximal site. Then the adenosine is hooked to a port most proximal and a 10cc flush in the same port side by side. Adenosine is pushed as fast as possible with another nurse pushing the flush directly after. The Dr is standing at bedside.

[Hilinenursegrl]

We have the doc in the room, two nurses, although our IV's have a port to hook the Adenosine and one to connect the flush so bothe can be given rapidly. This med NEEDS to be given rapidly.

[meandragonbrett]

We give it. Sometimes a physician is present and sometimes not. Always have defib at bedside.

[mpccrn, BSN, RN]

we push adenosine on patients as long as they have a monitor on......telemetry included.......we just tell someone to watch the monitor, and run a continuous strip. i never had to code a person following adenosine. actually hung a continuous adenosine gtt once.......learn something new everyday

[tgb3rn]

Small town hospital in the middle of nowhere. I work 7p-7a, the doc is at home in bed, 2 other RN's on the next floor. I'm it in the ER, lab, xray, r/t are all in bed at home but on call. When this happens where I am, I call another RN down and call in the Doc. If it was SVT and the Pt is in acute distress (as in do it now or never) in it goes but the pads would be in place.

Tom