Do you have an SOP for patients who vagal?

[tippeny]

The specialty clinic that I work in is overhauling how we treat patients who vagal in the clinic. We see derm, GYN, and GI patients and have at least 2 or 3 patients each week who vagal after minor procedures (IUD insertion, skin biopsy, etc). We typically grab an ice pack, lie the patient back, grab a set of vitals and BG, and wait for it to pass. But earlier this week we had an anxious RN grab an IV kit and talk about calling 911. The patient had a punch biopsy, was small in stature, not dehydrated, and did not loose consciousness. Vitals and BG were normal. Mind you, there were also MDs just standing around watching her spin in circles. Does anyone have guidelines or an SOP, aside from calling 911 or rapid response, for patients who simply vagal or have a pre-syncopal episode? Thanks!

[lpn164]

This is old but hopefully my response will help future nurses. We have a LONG running LPN in our office 25 years+ in nursing if not more, you would think she would be a great educator or mentor to go to but she is the complete opposite. She calls 911 all the time it is so embarrassing. I am so glad I don't work close with her. She scares the patients to death in the process and 50% of the time they do not make it far past triage before getting sent home. Don't overthink it. She recently called 911 for this EXACT thing. Male in his 50's/60's had a vagal episode in the exam room while attending his wellness visit - no complaints. She never documented repeat vitals (not sure if she checked them or not since no documentation) and didn't use any skill to obtain a glucose or EKG.

[T-Bird78]

My podiatrist I saw for an ingrown toenail has a saying—rear above the ear. He put me trendelenburg when I went vasovagal during a procedure and got his MA staff to help me out. LOL. Anyway, at my facility we get lie them back, get v/s, and use the lovely ammonia things to get them back. If it’s a real situation we’ll call 911, but just for vasovagal we don’t.

[RN John]

we have a system in our office with call buttons in each room (these can be purchased off amazon for a reasonable price) the buttons alert the nurse and lead MA in the lab of which room has an issue.  We also have walky talkies given to designated responders throughout the day.  If there is a situation such as a vaso-vagal, the nurse or lead MA is alerted and someone stays with the pt and assists them onto the bed or into a safe position if sitting.  We elevate the pt's knees and direct them to take slow deep breaths while taking manual vitals and calming/re-assuring the patient that a vaso-vagal is common and should pass in a few moments.  Typically the patients walk out under their own power after a few minutes to recover assuming stable vitals.  We may get 1-2 vaso-vagals or near syncope with injections per month on the high side.  We also get about the same amount of injection site pain/cramping reactions which are helped with Ice packs and massage and typically only last a few minutes.