SVT...from what?

Any time somebody goes into SVT, something happened immediately prior. Just because the events are sequential,does not mean they are connected.

For example, if somebody is eating popcorn, or knitting when they go int SVT doesn't mean either of those activities caused it.

And, I very much doubt that tiny air bubbles did anything. Unless maybe you yelled "Holy Cow! Air bubbles!" and made them scared or agitated.

Thank you for responding, sometimes as a new nurse I let my worries get the best of me. Haha no yelling was involved!

Was the PICC into the right atrium? That can cause SVT. In NICU pts anyway.

There are reports linking Dromp with ventricular arrhythmias and sudden cardiac death. It's contraindicated in people with cardiac disease' prolonged QT and/or electrolyte disturbances. No mention specifically of SVT, though. As already noted, catheter location, particularly the tip can propagate arrhythmias...it also has been mentioned that none of the previous directly contributed to the SVT.

Was the PICC into the right atrium? That can cause SVT. In NICU pts anyway.

Thats what I was curious about, maybe irritating the heart muscle from catheter tip movement aye? Maybe the PICC's a bit too far in?

I remember a random nugget from nursing school about pacemakers and hiccups not being a very good thing when they are had together, kinda like a pulsating Trach. Hmmm moments indeed!

Tiny bubbles? No.

Domperidone? No. (something tells me that it was not the single med the patient was on... is it true?)

PICC too deep in? Hardly so.

SVTs basically caused by two groups of things:

- sudden surge in cathecholamines (fear, pain, panic attack, agitation, hypoglycemia, nausea/vomiting (yep, they are symptomatic for vagal activation, but cause cathecholamine surge as well), thyrotoxicosis, idea of Donald Trump taking over the USA... whatever), or

- existence of Kent bundle and other abnormal electrical pathways in the heart, through which the impulse starts running as re-entry. Almost everybody has some of these pathways - this is why sudden downing of AV block as a result of, for example, inferior MI, doesn't kill instantly. Not everyone has these pathways'exitability so high as to become source of SVT.

Too deep PICC can cause irritation of these bundles. This is why ice-cold solutions, highly concentrated things like 10% Ca gluconate, high pressure flows, etc., are not to be pushed quickly through them. But unless you pushed 20+ cc like fire hydrant, the PICC can hardly be blamed.

Many, if not most, of SVTs are in fact spontaneous, so unless you pushed something real hard in, or truly royally upsetted the patient, do not search for "something you might do wrong". In fact, you probably did nothing wrong. SVT just happen sometimes.

20 Apr 2012: Domperidone and risk of cardiac arrhythmia or sudden cardiac death

Domperidone Restrictions Endorsed in EU Due to Cardiac Risk

PRAC Wants Restrictions on Domperidone Due to Cardiac Risks

Summary Safety Review - DOMPERIDONE - Serious abnormal heart rhythms and sudden death (cardiac arrest)

20 Apr 2012: Domperidone and risk of cardiac arrhythmia or sudden cardiac death

Domperidone Restrictions Endorsed in EU Due to Cardiac Risk

PRAC Wants Restrictions on Domperidone Due to Cardiac Risks

Summary Safety Review - DOMPERIDONE - Serious abnormal heart rhythms and sudden death (cardiac arrest)

These are all about ventricular arrythmias. SVT is kinda a different animal.

Did they do a chest x-ray? Sometimes the PICC gets stuck against the SVC wall or passed down into the right atrium which can cause just enough of an irritation to cause a dysrhythmia.

Did you get to watch the cardioversion? Always an interesting thing to see. Glad the patient is ok!

Next time a patient goes into spontaneous SVT tactfully ask her, but usually him, when was the last time you consumed an alcoholic beveveage?

Inducing spontaneous SVT secondary to drawing blood from a picc line seems a bit like a red herring in this matter. Nonetheless, I would defer to the picc experts for insight and clarification as I really dispise myself, in most instances, that boarder on all matters smart-ass.

But still ask about the ETOH.

Were they admitted for something cardiac related?

These are all about ventricular arrythmias. SVT is kinda a different animal.

Very true. I didn't pick that up - I was more looking for a correlation between the drug and cardiac abnormalities than the specific arrhythmia. Though seeing that this drug potentiates arrhythmias, I wouldn't rule it out.

That being said, PICC tip placement confirmation wouldn't hurt.

As a side note, has anyone seen an actual pause when pushing Adenosine? I remember being so excited the first time I did it and the patient just gradually dropped his rate over the course of a couple minutes. I was expecting this massive dramatic sinus pause.