ADENOSINE ??

  1. 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. The MD in the room was telling me that her arm needs to be raised when giving her the medication. I have heard that this is a myth. As long as you inject it quick enough and then flush it you are good to go....... Please tell me what is your opinion? Do you raise the arm or not ?
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    About laurainri

    Joined: Feb '06; Posts: 137; Likes: 15
    ED RN; from RI
    Specialty: ED

    35 Comments

  3. by   Be_Moore
    I'd say that's a myth, as ACLS protocols don't teach it. I just got ACLS cert. in February...so the latest knowledge doesn't mention doing it. I can see his logic...but I don't think it's significant.
  4. by   Virgo_RN
    It's more important to administer through an access as close to the heart as possible and to follow with 20mL rapid flush.
  5. by   vamedic4
    Not to mention the fact that raising the arm can cause all kinds of chaos...Imagine having your only IV pulled out by someone in the process of raising that arm?! It's chaotic enough when situations like that arise, no need to do anything unorthodox when, as Virgo stated, a 20 mL flush post med administration usually works just fine.
  6. by   GilaRRT
    Remember, AHA does not make protocols. AHA publishes guidelines that physicians can can use when protocols are developed.

    In addition, some battles are not worth the time or effort. If you are pushing adenosine, you should have a "stable" patient. Therefore, I do not accept the IV getting pulled in a chaotic situation argument. It's up to you if you feel strongly enough to make an issue of this practice.
  7. by   JDCitizen
    One hospital I worked in the MD had to psychically push it themselves... I have never seen or used the raised arm procedure.

    Quick push, quick flush and be prepared for the sometimes unfavorable results.

    I have never seen the event of pushing adenosine as being a stressful event but I have seen the results of adenosine turn the situation into a stressful event. Every hospital I have worked in the crash cart is to be inside the room. Usually didn't matter since that was were the portable monitor was anyway.

    I am not in favor of putting a life line at risk....
  8. by   canoehead
    Years ago we were taught to raise the arm. It gives me something to do while waiting for the inevitable. It also gives me a reason to stay right by the crash cart/IV access just in case. If the patient feels that impending doom and decides to move they can't cause I've got hold of that arm.
  9. by   DebanamRN
    I was taught to raise the arm. I agree with having a hold of the pt, sometimes they get very frightened when the adenosine hits. I assist the RN or MD with the procedure, and if the IV is in the hand, I don't think elevating the arm can hurt. Some of these folks just don't have great IV access and we have to improvise. Putting that stuff thru a 24 gauge IV is no fun (we have a very large senior population).
  10. by   JDCitizen
    Quote from canoehead
    Years ago we were taught to raise the arm. It gives me something to do while waiting for the inevitable. It also gives me a reason to stay right by the crash cart/IV access just in case. If the patient feels that impending doom and decides to move they can't cause I've got hold of that arm.

  11. by   Roy Fokker
    Quote from debanam
    Putting that stuff thru a 24 gauge IV is no fun
    DAAAANG!!!! No IJs/EJs?

    cheers,
  12. by   laurainri
    Thank you so much for all you help. This is the type of MD that if I had raised to arm she would have said that there was no need to do it. But because I did not raise it she had to say something.
  13. by   glasgow3
    Quote from Be_Moore
    I'd say that's a myth, as ACLS protocols don't teach it. I just got ACLS cert. in February...so the latest knowledge doesn't mention doing it. I can see his logic...but I don't think it's significant.
    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.
  14. by   Roy Fokker
    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.
    (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,

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