Help with amiodarone drip

[healthcare4life]

Had an admission with new onset a fib with RVR. Pt was stable when she came to my floor, however her a fib came back with HR jumping to 150s, down to normal, then jumping to 160s. Although vitals were stable and pt was in no acute distress--converting on and off to NSR.

I told the MD of the above and he was quick to say "ok put the pt on amiodarone drip" and just hung up.

In administering an amio drip do you wait until the a fib is persistent for so long?

More info: pt was asymptomatic and resting comfortably in bed. Apical pulse, however, was irregular.

Blood thinner was started immediately on my shift.

What would you have done in this situation?

Thank you for any response.

[Beverage]

Start the gtt. We have a protocol for a bolus loading dose, followed by a 6 hour infusion at 1mg/min then a maintenance dose of 0.5 mg/min. Amio needs a filter. Watch for hypotension and bradycardia.

[healthcare4life]

So you would've started the drip even if the pt converted back to NSR?

[MunoRN, RN]

Amio isn't just used to convert patients out A-fib, it's also to maintain SR. If the MD wasn't aware that the patient was in and out of A-fib, as opposed to persistent A-fib, it might be worth notifying the MD of that, but from your description it sounds like the MD was aware of that.

[michlynn, BSN, RN]

I agree with Beverage. I work on a cardiac floor and we have amio protocol, loading dose goes in over 10 min then 1mg/min. Amiodarone isn't just to convert them it's also to maintain a stable heart rate. Typically if the patient tolerates the IV and HR remains stable then they'll convert them to PO. So to answer your question, yes I would have started the drip as ordered. Hope this helps!

[Esme12, ASN, BSN, RN]

The sooner the rhythm is addressed the easier it is to convert....flipping in and out of AF is hard on the heart and patient even if they are asymptomatic.....yes I would have started it...and by the way....they aren't blood thinners....they are anti-coagulants. Anticoagulants do not "thin" the blood. They decrease blood clotting to decrease the chances of a clot in the heart from causing stroke or clot in a vein traveling to the lungs by preventing it from growing larger while the body's natural processes break it down for disposal.

they aren't blood thinners....they are anti-coagulants.

I always chuckle when I hear 'blood thinner.' The real blood thinners are the liters of fluid with which we bolus people. Everything else either inhibits or augments physiological processes.

[MunoRN, RN]

Maybe it's because I'm utilizing the "paint thinner" definition, but I've never agreed with the belief that anti-coagulants are not "thinners".

"Paint thinner" isn't necessarily used to change the consistency of paint or other finishes, what it's usually used for is to extend the time it takes for the paint to become a solid, ie for it to coagulate. In other words, paint thinner is used typically as an anti-coagulant.