Adenosine used as diagnostic on Med/Surg floor?

[michiemikala]

I work on a "Cardiology" floor that has the monitoring capabilities of a Med/Surg floor and ratio of 1:4. Frequently the Cardiologists want to push Adenosine for diagnostic purposes, to determine if there is a underlying rhythm. Dr's say they don't want the patient on a defibrillator and what are we so scared of? The patient is on telemetry. We're all ACLS certified, right? Is this a common practice on Med/Surg floors?

[LovingLife123]

I thought when pushing Adenosine they had to have the pads on them.

Our floor nurses are not ACLS certified to my knowledge. They can if they want to be, but it’s not required like in the ICU.

[RNperdiem, RN]

Look to find an actual written policy. Hospitals love their policies. Then you can tell the overly optimistic cardiologist that according to the Adenosine policy, the patient needs to be in a procedural area or ICU and the following emergency supplies need to be at the bedside.

[ruby_jane, BSN, RN]

28 minutes ago, RNperdiem said:

Look to find an actual written policy. Hospitals love their policies. Then you can tell the overly optimistic cardiologist that according to the Adenosine policy, the patient needs to be in a procedural area or ICU and the following emergency supplies need to be at the bedside.

^YAAAAS!^

I actually don't work with adenosine anymore but this question interested me...

[michiemikala]

There isn't a written policy other than it is not listed in our authorized push list for our floor. It is listed under ACLS medication. We have tried to show the physicians but it doesn't matter. I think they should be in a procedural room or ICU.

[AceOfHearts<3]

Icu nurse here. We have a continuous ekg going and have the patient hooked up to the defibrillator any time adenosine is given.

[MunoRN, RN]

I'm not sure what you're describing your monitoring capabilities to be, "med/surg" typically refers to a floor without continuous cardiac monitoring, but you also mentioned the patient is on tele. Patients on telemetry with a 1:4 ratio is typical of a tele or progressive care unit, not a med/surg floor.

At every place I've worked we have a defib at the bedside and pads ready to go, but we don't actually place them since the need for defibrillation is low, the incidence of a sustained shockable rhythm is pretty similar to that of a number of other drugs that we don't routinely place defib pads for.

[Horseshoe, BSN, RN]

My ICU experience is old now. We didn't put defib pads on someone receiving adenosine, though certainly crash carts and ACLS meds were literally merely a few feet away at all times.

What rhythms are the most common observed after adenosine administration? Never in my experience did I get a shockable rhythm after giving it, but that's just one person's experience.