When to call doctor about pvc’s?

[Alinaa]

What is the minimum number of pvcs in a row for you to call the MD?

[LovingLife123]

It depends. What does their K and Mg look like? Do those need treated first? Have they been treated and are you still having them?

I don’t get too excited about PVCs because it’s usually due to low potassium. But if everything looks good and they are still have them, I will mention it. The doctor usually requests a 12 lead EKG and it turns out to be nothing.

[Just me.]

Does your facility have standing orders for PVCs? Ekg or labs to be repeated?

Our standing orders were usually for so many in a row. If the pt needed these I would call, or if the pt was symptomatic

[yournurse]

In my facility, we have standing orders to replace electrolytes and to do an EKG for abnormal rhythm.

after I’ve replaced magnesium and K, if MAP is <65 or SBP <90, or symptomatic and an EKG.

[adventure_rn, MSN, NP]

Maybe it's different in peds, but it seems odd to me that you'd measure it as 'how many in a row.' 3 in a row is technically V-tach, and it seems like you should be preempting that.

I'd argue it depends so much more on the patterns/frequency of the PVCs than how many there are in a row. If there's a single PVC every 20 minutes or so, then it's probably no big deal and can wait. If there's a single PVC every minute or so, then it may be a bigger deal. If they're in a pattern (trigeminy, quadrigeminy, couplets, etc.), then I'd definitely let somebody know.

I agree with @LovingLife123 that in 90% of cases it's just an electrolyte imbalance, the EKG looks fine, and it's no big deal. In my experience, the worse the electrolyte imbalance, the more frequent the ectopy will be; for instance, you might go from beats in quadrigeminy to trigeminy to bigeminy, or you might go from single PVCs to couplets to triplets (V-tach).

I think that the answer depends a lot on your patient population. If you're in med-surg caring for a patient without a significant cardiac history and your patient has random PVCs once an hour, you probably don't need to tell the provider right away. If you're in a tele unit caring for a post-cath patient on high-dose diuretics, or if you're in a cardiac unit with a patient on dialysis with new-onset or worsening ectopy, you probably need to tell somebody sooner rather than later.

Like @Just me. said, I'd check to see if you have standing orders. If not, I'd ask your charge nurse. Regardless of the frequency, I'd also eventually pass it along to the provider at some point; even if it's just a random PVC here or there, they might want to check lytes with your routine labs. However, I wouldn't personally wake a hospitalist up in the middle of the night over a random occasional PVC.

[AlwaysLearning247, BSN]

If my patient goes from having occasional PVCs to more frequent PVCs or a few runs of vtach, I will call to get labs ordered. Most times an EKG doesn’t show anything, unless they’re having runs of vtach as the EKG leads are attached. My concern is with how the patient looks, has it been happening, what do the labs look like, what were they doing while it happened, etc. PVCs really aren’t cause for alarm unless they’re super frequent or the patient is symptomatic. Some patients will have frequent PVCs and PACs with no abnormal lab results and be asymptomatic.