Adensonie

[FirstLadyRN]

Recently patient was delivered to me in SVT 180 with blood pressure 75/45. Telephone order received for adenosine. Administered 6mg than 12mg to convert to sinus rhythm. Pushed hard; fast and flushed well. Watched the monitor.

Later Charge RN said I shouldn't have done this without MD at bedside. No protocol states I couldn't or outlined any details outside of ACLS. In review; I acknowledge recommendations of pacer pads, nearby crash cart, additional nurse RT in room.

I see the benefits in regards to a possible asystole pause. But I do not see where I was wrong in administration with doctors order.

Side notes: clinical setting ICU; acls provider (so I was familiar and comfortable with the drug). Again, no outlined protocol defining adenosine use and no restrictions in the Florida's nurse practice act.

Thoughts and opinions welcomed

[Lev, MSN, RN, NP]

If it is not against hospital policy, I don't see where you went wrong.

[Nalon1 RN/EMT-P, BSN, RN]

I see no issue with it either.

As a paramedic I gave it many times, but that is a different area. So long as you had a valid order, you should be good to go if your comfortable with it.

ACLS protocols are usually a standard that (ER and ICU) nurses can treat, sometimes without even a MD order. With an order and depending on hospital policy, do it.

Defib/pacer pads on is a must, as is a 2nd nurse just in case. There is always the chance of v-fib being the new rhythm after pushing it

[Emergent, RN]

In my ER, we always have pt on defibulator, with doc in room, and usually 2 RNs. We hook up a NS bag with a 20 CC syringe up at the top port. One nurse is in charge of the flush from that. Other nurse administers the drug, "123 Flush!". Doc watches the monitor, ER tech does follow up EKG. it's all good, clean fun!

[Pheebz777, BSN, RN]

Yes, as Emergent RN stated above, the patient should always be connected to the "defibrillator". But instead of having 2 nurses push the adenosine, you can just hook up a 3 way stop cock, place the adenosine on the lower port, and have your saline flush on the upper port.

There is a lot of dead space using the higher up port of a regular primary IV line. And you don't need 2 nurses to administer the med.

[Wrench Party]

Just did this last night for the first time. Pt was in SVT in the 150s, didn't break after 6 mg adenosine. He was hooked up to pacer pads, the monitor, the BP cuff, the works. I apologized to him before I pushed the 12 mg, then he did the 'look of death' and snapped right back to NSR. I love me some cardiology!

[Emergent, RN]

Yes, as Emergent RN stated above, the patient should always be connected to the "defibrillator".

I knew I was misspelling that!

I was so off, my spell check couldn't figure out what in the world I was trying to say!

[Pheebz777, BSN, RN]

Just did this last night for the first time. Pt was in SVT in the 150s, didn't break after 6 mg adenosine. He was hooked up to pacer pads, the monitor, the BP cuff, the works. I apologized to him before I pushed the 12 mg, then he did the 'look of death' and snapped right back to NSR. I love me some cardiology!

Wait til you do some synchronized cardioversion after failed adenosine attempts! You'll be loving this cardiology!

[calivianya, BSN, RN]

You don't need a physician to be present - technically, you don't even need the physician to give you the order. Most places (at least, most I've worked) have ACLS as standing protocol - as in, if the patient meets the criteria, you can do the intervention. Just like if the patient scores a high enough score to be a fall risk, you don't have to call the MD to ask for an order to put a fall risk bracelet on. ACLS interventions are in your scope of decision making if you are ACLS certified, and you can put the orders in the EMR as "Per protocol, no cosign required" when you go and put the med orders in later.

It is, of course, common courtesy to inform the MD that you are pushing adenosine on his patient, though. He might want to be present but his presence is optional.

[russianbear]

Even though I am an ER nurse, ACLS certified, TNCC, blah, blah, blah, I think it's a bit arrogant to do this without a physician present especially if one is easily accessible.

[Nalon1 RN/EMT-P, BSN, RN]

Even though I am an ER nurse, ACLS certified, TNCC, blah, blah, blah, I think it's a bit arrogant to do this without a physician present especially if one is easily accessible.

So it is arrogant to follow a valid order and help a patient?

Sure if the physician is nearby and can be in there in a minute or two, but this is the ICU, not ER. Sometimes it is quite a while till a MD can get up there.

[Armis27]

Our policy doesn't require an MD at bedisde in ICU. we just set everything up for a code. An MD is required on lower levels of care because usually only the charge nurses are acls certified. Personally I would want to have a competent team ready to code the patient.