SVT...from what?

[Hockeynursing]

First thing on my shift, I had a patient go into SVT right after I drew blood from PICC. I was very careful to get air out of syringes but saw tiny bubble go in ( dressing and caps were changed last night ). I'm wondering whether this tiny bubble could cause SVT? The patient had no other symptoms, no chest pain, no dyspnea, blood pressure was on high side of normal.

Pharmacy thought it may be due to a medication (domperidone). Patient was cardioverted and seemed okay later on.

Experienced nurses! Thoughts?

[MaxAttack, BSN, RN]

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.

[KatieMI, BSN, MSN, RN]

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.

Saw it and did it a few times. Patients (those who are still here, that is - I try my best to give them at least a touch of Versed but blood pressure may not allow it) usually feel it as well. Many of them are so frightened by this experience that they tell that they are allergic to Adenosin and some of them for very real prefer external cardiovertion, which hurts A WHOLE LOT but at least you do not literally feel your heart stopping.

[Wile E Coyote, ASN, RN]

If I don't see a pause after my fast push, I'm troubleshooting how I can improve the odds of it happening for the repeat dose...that translates to yes, I see a pause the majority of the time. In Max Attack's scenario above, that slowly decreasing HR over several minutes was absolutely not due to the IV Adenosine, if it wasn't already clear to you before.

[MaxAttack, BSN, RN]

that slowly decreasing HR over several minutes was absolutely not due to the IV Adenosine, if it wasn't already clear to you before.

I don't think I'd say absolutely, considering it's been several times with the ER doc present. I've also read that it's more likely to happen with the 12 mg (second dose) than the 6 mg, which I've never gotten to. The patient definitely felt it, either way.