Afib

Published

New onset a fib. What should I do , prepare to hang vasopressor or administer anticoagulants?

Up Vote Up Vote ×

We need assessment information. What is your thinking behind vasopressors?

Up Vote Up Vote ×
Specializes in Critical care.

Whoa! Vasopressors are serious drugs that require central lines and are definitely NOT the first line of treatment for symptomatic afib. Many people with afib are actually asymptomatic.

What other drugs are there that would be a better choice than just starting a vasopressor? Think of what drugs we use for rhythm and/or rate control.

Besides drugs, what is the other big treatment we do with afib, especially in a hemodynamically unstable patient? What big concern do we have with it? It's a potential major complication that is impacted by blood flow and time.

Up Vote Up Vote ×

This is a typical nursing "gotcha" kind of question. Your two answers are both not what you'd immediately consider in this patient. The point of the question isn't necessarily that you, as an RN, know all about afib, rather it is to try to get the test taker to rule out the most wrong answer and to thereby become a better test taker.

So the vasopressor (you don't need a central line for one) is for hypotensive patients. You aren't told if this patient is hypotensive or not, but if he were, synchronized DC cardioversion would be indicated, not a vasopressor. So you've ruled out that answer. The only one left is anti-coagulation which isn't as wrong as the vasopressor (it also isn't something you'd think about right away, but there it is...) so you'd pick that on your test.

1
Up Vote Up Vote ×
Specializes in Critical care.
This is a typical nursing "gotcha" kind of question. Your two answers are both not what you'd immediately consider in this patient. The point of the question isn't necessarily that you, as an RN, know all about afib, rather it is to try to get the test taker to rule out the most wrong answer and to thereby become a better test taker.

So the vasopressor (you don't need a central line for one) is for hypotensive patients. You aren't told if this patient is hypotensive or not, but if he were, synchronized DC cardioversion would be indicated, not a vasopressor. So you've ruled out that answer. The only one left is anti-coagulation which isn't as wrong as the vasopressor (it also isn't something you'd think about right away, but there it is...) so you'd pick that on your test.

I'm not sure where you work that running a vasopressor through a peripheral site is ok other than for an extremely short amount of time. I've done it for less than hour before, but with the risk of extravasation it's not something I like doing. Having a patient on a vasopressor is one reason why a central line is clinically indiciated/necessary at my hospital.

Up Vote Up Vote ×
I'm not sure where you work that running a vasopressor through a peripheral site is ok other than for an extremely short amount of time. I've done it for less than hour before but with the risk of extravasation it's not something I like doing. Having a patient on a vasopressor is one reason why a central line is clinically indiciated/necessary at my hospital.[/quote']

The critical care literature does not support your hospital's indication for central lines with pressors. Do you need a good vein? Yes. Reliable access? Yes. Central line? No. But if that's your policy, do it. I run NE routinely for hours through peripheral IV's.

2
Up Vote Up Vote ×
Specializes in CVICU.

New onset MAY buy you a heparin gtt, cardizem gtt, or amiodarone gtt. Most Afibs need some type of anticoagulation to prevent clots from forming esp in the left atrial appendage.

Up Vote Up Vote ×
Specializes in ICU, CVICU, E.R..
I'm not sure where you work that running a vasopressor through a peripheral site is ok other than for an extremely short amount of time. I've done it for less than hour before but with the risk of extravasation it's not something I like doing. Having a patient on a vasopressor is one reason why a central line is clinically indiciated/necessary at my hospital.[/quote']

It's not uncommon to run vassopressors through peripheral veins. As long as you have a good vein, the more proximal to the heart and bigger the catheter the better. If patient condition warrants a central line it doesn't hurt to run pressors through a PIV prior to central line placement as long as you have a reliable access.

But I've never come upon a facility that has a policy to run "ALL" pressors throught central lines, and I've worked in 8 different ICUs as full time, agency and part time.

Up Vote Up Vote ×
Specializes in Nurse Anesthesiology.
I'm not sure where you work that running a vasopressor through a peripheral site is ok other than for an extremely short amount of time. I've done it for less than hour before but with the risk of extravasation it's not something I like doing. Having a patient on a vasopressor is one reason why a central line is clinically indiciated/necessary at my hospital.[/quote']

Key words in your statement is "MY HOSPITAL." You do NOT need a central line for vasopressors. Many people do things because it is "policy" and I get that but you have to stop thinking we do stuff because thats what they want and start thinking of doing stuff based off actual evidence based research. Having an IV infiltrate with a vasopressor is not good and I get that, but if you are not willing to do stuff based off every possible side effect then I wouldn't give a single med to my patients in fear of killing them.

1
Up Vote Up Vote ×
Specializes in anesthesiology.

Offlabel and passinggas, It is quite obvious from your posts you work in anesthesia (also passinggas is a bit of a giveaway ;). Being able to think for yourself and getting away from policies as a safety net from taking on personal responsibility for your actions or understanding what you're doing is one of the great things about your job.

Up Vote Up Vote ×
+ Join the Discussion