ADENOSINE ?? - page 2

We had a Pt earlier this evening with SVT. HR 190's ...young girl ( no drug use can you believe it). I was administering Adenosine with a stop cock knowing that it only has a 6 second half life. ... Read More

  1. by   flightnurse2b
    Quote from glasgow3
    Well, keep in mind ACLS doesn't teach MANY things in the interest of cost containment; today's ACLS courses are but a ghost of their former "selves". But I digress.........


    I have been an ACLS instructor for in excess of 15 years and the extremity elevation maneuver for resuscitation drugs has always been a part of the course....and Moore...they STILL ARE.

    This is ALSO true of adenosine....you are to follow with a 20 cc saline flush and elevate the arm immediately.

    Now, do I have an authoritative/evidenced based source as to the maneuver's effectiveness?---nope. But it IS what you should have been taught in an ACLS course.

    i was going to say that too... i just renewed my ACLS in may and people got points off their megacode for not raising the arm... that was something i was always taught to do. not saying it happens often in the codes i've worked, bc it doesnt... and i'm not sure how effective it is, but that's what i've always been taught in ACLS.
  2. by   Virgo_RN
    Quote from glasgow3

    Now, do I have an authoritative/evidenced based source as to the maneuver's effectiveness?---nope. But it IS what you should have been taught in an ACLS course.
    I wasn't. In fact, when I asked about it, they all rolled their eyes and said it's not necessary.
  3. by   glasgow3
    Quote from Roy Fokker
    (emphasis mine)

    That's an interesting statement/claim.
    To state that there is no 'evidence based source' as to the effectiveness of an intervention but still insist that providers 'should be taught' as such.

    Interesting.

    cheers,
    Fair comment, so let me clarify.

    If you picked up a provider manual from the AHA for ACLS including the most current you would find that you should perform the arm elevation manuever.

    Now that said...over the years I've learned that in ACLS there can be significant lags between when ACLS incorporates the most current research into their guidelines/courses...and sometimes the recommendations aren't supported by the strongest of evidence, just the best available evidence at the time the guidelines were formulated.

    I don't know whether anyone has ever demonstrated in a research paper the superiority of arm elevation in converting SVT with adenocard over nonelevation----but I DO know it's a part of ACLS and should be taught.
  4. by   glasgow3
    Quote from Virgo_RN
    I wasn't. In fact, when I asked about it, they all rolled their eyes and said it's not necessary.
    Well, next time they roll their eyes for asking a perfectly valid question, simply direct them to the middle of page 101 in the pamphlet that they call a Provider Manual these days; the basic course has been "dumbed down" to such a degree that these days even many of the instructors have never had to totally master the material.
  5. by   Virgo_RN
    These instructors have been teaching ACLS for a very, very long time, and are well aware of what is in the manual.
  6. by   nrsang97
    I was never taught to raise the arm either.

    I am curious do any of you have the 12 lead on while giving adenosine? We do that in my neuro ICU, plus the paddles, and wall mounted EKG.
  7. by   flightnurse2b
    Quote from nrsang97
    I was never taught to raise the arm either.

    I am curious do any of you have the 12 lead on while giving adenosine? We do that in my neuro ICU, plus the paddles, and wall mounted EKG.
    on the unit i work on, we have to have the patient not only hooked to the monitored tele box, but they have to be hooked to the defib with paddles in place, crash cart and a cardiologist @ bedside. its my hospital policy that on the floor (i think its different for ICU and ER) no one can give adenosine unless there is a doc present.
  8. by   loricatus
    In trying to reason out this arm raising thing, I got to thinking that what good is arm raising when the veins have valves? Now, if you were to raise the arm and provide mov't or massage, then blood flow will be supplemented; otherwise, it just seems it would be as equally effective to raise your arm an not the patient's.

    Am I just too tired, or does this make any sense?
  9. by   JDCitizen
    Probably akin to the pericardial thump and a few other maneuvers over the years or when bertillium was going to replace Lidocaine...




  10. by   mwboswell
    ...but DOES IT REALLY MATTER????

    PS: Does my IVF run faster if I elevate the arm????
  11. by   GilaRRT
    Quote from mwboswell
    ...but DOES IT REALLY MATTER????

    PS: Does my IVF run faster if I elevate the arm????
    Agree. At the end of the day, this is not a big deal compared to all the other knuckle-headed things I have seen.
  12. by   canoehead
    Quote from mwboswell;3669871PS:
    Does my IVF run faster if I elevate the arm????
    Presumably the fluid inside the arm will flow faster going downhill, and you should have already gotten the med and flush in before raising the arm. I don't think it matters much, but I do like to have physical contact with the patient for that feeling of doom moment. I don't know if it helps them, but I hate to frighten someone so much without trying to provide some comfort.
  13. by   PAERRN20
    Hmm...I was taught to raise the arm in ACLS too. If I know I am going to be giving Adenocard I put a 20g in the AC. I know floor nurses hate this spot but I'm an ER AC loving nurse. (Sorry!! Hehehe) Anyways my reasoning behind this is the the AC is a large vein, lots of flow, closer to the heart than say a hand vein, and the 20g can tolerate a rapid 20cc bolus much better than something below the wrist.

    We don't have to have a doctor in the room while we push Adenocard. In fact they rarely are. The patient is on the monitor and the EKG machine is near.

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