How to administer adenosine IV?
Trick of the Trade: Combine the adenosine and flush solution in one syringe.
- Grab a 20-mL (or 30-mL) syringe.
- Draw up the adenosine AND the normal saline in the same 20-mL syringe.
- Administer via fast IV push (can be through a running IV line).
When not to give adenosine?
We have the option to use adenosine for HR greater than 150 that are narrow (or patch for a consult for monomorphic wide complex if we think it could be SVT with aberrancy) but we do not give it for rapid AFib, do not give it for aflutter (if we can differentiate between 2:1 conduction , sometimes it's tough).
How do you give IV amiodarone as IV push?
- Class I: Blocks sodium channels that are rapidly firing. Example: Lidocaine, Procainamide, Phenytoin
- Class II: Blocks beta-adrenergic receptors. Example: Propranolol, Esmolol, Metoprolol
- Class III: Blocks potassium channels lengthening cardiac action potential. ...
- Class IV: Blocks L-type Ca Channels Example: Verapamil, Diltiazem
What is IV push medication administration?
Intravenous (IV) push administration can provide clinical and practical advantages over longer IV infusions in multiple clinical scenarios, including in the emergency department, in fluid-restricted patients, and when supplies of diluents are limited. In these settings, conversion to IV push administration may provide a solution.
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Why is adenosine given rapidly?
In man adenosine administered by rapid intravenous injection slows conduction through the AV node. This action can interrupt re-entry circuits involving the AV node and restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardias.
Why is adenosine adenocard given to a patient rapidly by intravenous IV push?
Adenocard (adenosine injection) slows conduction time through the A-V node, can interrupt the reentry pathways through the A-V node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT), including PSVT associated with Wolff- Parkinson-White Syndrome.
What happens if you give adenosine slowly?
Adenosine will slow, not terminate, atrial fibrillation and atrial flutter allowing an accurate diagnosis to be made (which is frequently difficult when the heart rates are fast). Due to the short half-life, the saline flush is very important or else the drug may be completely metabolized before it reaches the heart.
Can you push adenosine?
There are a variety of methods to administer adenosine. Some will push it through a running IV line, followed by two 10-mL saline flushes. Others will utilize a stopcock, where the adenosine is hooked up to one port and a 10-mL saline flush is hooked up to the other.
What happens if you give adenosine to sinus tachycardia?
Intravenous adenosine during sinus rhythm is capable of producing AV nodal conduction delay or block in 73% of patients with a history of supraventricular tachycardia: in these patients adenosine provides a diagnostic test that is both 100% sensitive and 100% specific for latent preexcitation.
How does adenosine affect heart rate?
In the heart adenosine decreases heart rate and also decreases the speed with which impulses flow between the heart muscles to bring about a contraction. Adenosine acts in opposition to adrenaline and also possesses anti-platelet action that prevents platelets from aggregating.
Can you push adenosine for V tach?
Adenosine is a safe and effective agent in PSVT. It's currently the EMS drug of choice for regular tachycardias about 150—160 beats per minute, believed to be PSVT–whether wide or narrow.
What are the key nursing considerations when administering adenosine?
Nursing considerationsContinuous ECG printout during and immediately after administration IS ESSENTIAL. ... Where practical record blood pressure prior to first dose.Continuous cardio-respiratory monitoring. ... Monitor and assess patient response to therapy.Observe for signs of adverse effects and arrhythmias.More items...•
What happens if you give adenosine to atrial fibrillation?
Atrial fibrillation (AF) is a potential adverse effect of intravenous administration of adenosine. Although the mechanism is not known, this phenomenon is thought to be mediated by adenosine's effects on shortening atrial action potential duration and refractoriness.
How do you push adenosine SVT?
For the management of SVT, adenosine is ideally given through a peripheral intravenous (IV) access initially as a 6 mg dose followed by a 20 mL saline flush for rapid infusion. Subsequent doses start at 12 mg, also followed by 20-mL of saline for rapid infusion.
Why does adenosine stop the heart?
Adenosine is the drug used in this test. It belongs to a group of medicines called anti-arrhythmics. Adenosine blocks electrical signals through the atrio-ventricular (AV) node. This means signals cannot travel from the top to the bottom chambers of the heart for a few seconds, until the drug effects wear off.
Does adenosine slow heart rate?
Adenosine has a key role in the adaptive response in pulmonary hypertension and heart failure, with the most relevant effects being slowing of heart rhythm, coronary vasodilation and decreasing blood pressure.
How is adenosine metabolized?
Intracellular adenosine is rapidly metabolized either via phosphorylation to adenosine monophosphate by adenosine kinase, or via deamination to inosine by adenosine deaminase in the cytosol. Since adenosine kinase has a lower Km and Vmax than adenosine deaminase, deamination plays a significant role only when cytosolic adenosine saturates the phosphorylation pathway. Inosine formed by deamination of adenosine can leave the cell intact or can be degraded to hypoxanthine, xanthine, and ultimately uric acid. Adenosine monophosphate formed by phosphorylation of adenosine is incorporated into the high-energy phosphate pool. While extracellular adenosine is primarily cleared by cellular uptake with a half-life of less than 10 seconds in whole blood, excessive amounts may be deaminated by an ecto-form of adenosine deaminase. As Adenocard requires no hepatic or renal function for its activation or inactivation, hepatic and renal failure would not be expected to alter its effectiveness or tolerability.
How does adenocard work?
Adenocard (adenosine injection) exerts its effect by decreasing conduction through the A-V node and may produce a short lasting first-, second- or third-degree heart block. Appropriate therapy should be instituted as needed. Patients who develop high-level block on one dose of Adenocard should not be given additional doses. Because of the very short half-life of adenosine, these effects are generally self-limiting. Appropriate resuscitative measures should be available.Transient or prolonged episodes of asystole have been reported with fatal outcomes in some cases. Rarely, ventricular fibrillation has been reported following Adenocard administration, including both resuscitated and fatal events. In most instances, these cases were associated with the concomitant use of digoxin and, less frequently with digoxin and verapamil. Although no causal relationship or drug-drug interaction has been established, Adenocard should be used with caution in patients receiving digoxin or digoxin and verapamil in combination.
How long does adenocard last?
The half-life of Adenocard (adenosine injection) is less than 10 seconds. Thus, adverse effects are generally rapidly self-limiting. Treatment of any prolonged adverse effects should be individualized and be directed toward the specific effect. Methylxanthines, such as caffeine and theophylline, are competitive antagonists of adenosine.
How many bolus doses are there?
In controlled studies in the United States, bolus doses of 3, 6, 9, and 12 mg were studied. A cumulative 60% of patients with paroxysmal supraventricular tachycardia had converted to normal sinus rhythm within one minute after an intravenous bolus dose of 6 mg Adenocard (some converted on 3 mg and failures were given 6 mg), and a cumulative 92% converted after a bolus dose of 12 mg. Seven to sixteen percent of patients converted after 1-4 placebo bolus injections. Similar responses were seen in a variety of patient subsets, including those using or not using digoxin, those with Wolff-Parkinson-White Syndrome, males, females, blacks, Caucasians, and Hispanics.
Does adenocard slow sinus rhythm?
Adenocard (adenosine injection) slows conduction time through the A-V node, can interrupt the reentry pathways through the A-V node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT), including PSVT associated with Wolff-Parkinson-White Syndrome.
Is adenosine soluble in alcohol?
Adenosine is a white crystalline powder. It is soluble in water and practically insoluble in alcohol. Solubility increases by warming and lowering the pH. Adenosine is not chemically related to other antiarrhythmic drugs. Adenocard® (adenosine injection) is a sterile, nonpyrogenic solution for rapid bolus intravenous injection. Each mL contains 3 mg adenosine and 9 mg sodium chloride in Water for Injection. The pH of the solution is between 4.5 and 7.5. The Ansyr® plastic syringe is molded from a specially formulated polypropylene. Water permeates from inside the container at an extremely slow rate which will have an insignificant effect on solution concentration over the expected shelf life.
Can adenosine be used during pregnancy?
As adenosine is a naturally occurring material, widely dispersed throughout the body, no fetal effects would be anticipated. However, since it is not known whether Adenocard can cause fetal harm when administered to pregnant women, Adenocard should be used during pregnancy only if clearly needed.
What is adenosine used for?
Adenosine is a purine nucleoside that acts as a very useful ACLS Drug to often treat and diagnose stable narrow-complex SVT (Supraventricular Tachycardia). When administered, adenosine basically causes a short-term blockade of the AV node within the heart which with patients with SVT, can restore normal sinus rhythms.
How long does it take for adenosine to convert to sinus?
Observe the rhythm. If the drug is effective, the rhythm will convert to sinus within 1 to 2 minutes. If no effect is observed, give a rapid IV push of 12 mg adenosine dose, followed by NS flush. Throughout the whole process make sure to have continuous ECG monitoring.
How much adenosine to flush antecubital fossa?
Insert a large cannula in the antecubital fossa. Draw up 6 mg of adenosine in a 2 – 5ml syringe. Draw up a 20 ml Normal Saline flush. Connect the adenosine syringe to the top port of the cannula and the Saline flush to the back port.
What happens after adenosine is pushed?
After the adenosine is pushed, the swivel is switched and the 10-mL saline flush quickly follows. Others, still, will use a hybrid of these two methods. The problem with all of these approaches is that it takes time to switch syringes.
How to administer adenosine?
Trick of the Trade:#N#Combine the adenosine and flush solution in one syringe. 1 Grab a 20-mL (or 30-mL) syringe. 2 Draw up the adenosine AND the normal saline in the same 20-mL syringe. 3 Administer via fast IV push (can be through a running IV line).
How many saline flushes are needed for adenosine?
There are a variety of methods to administer adenosine. Some will push it through a running IV line, followed by two 10-mL saline flushes. Others will utilize a stopcock, where the adenosine is hooked up to one port and a 10-mL saline flush is hooked up to the other. After the adenosine is pushed, the swivel is switched and ...
Where is adenosine metabolized?
While most drugs are metabolized in the liver, adenosine doesn’t even make it that far, being metabolized in the erythrocytes and vascular endothelial cells. With this extremely short half-life (10 seconds), it is important to help it reach the heart before it’s metabolized and excreted without being effective.
Is adenosine a stable substance?
Adenosine is stable in, and compatible with, normal saline [2, 3]. Even if you’re giving a 12 mg dose, the adenosine will only take up 4 mL of volume, leaving 16 mL for the normal saline. A small study from Korea demonstrated the feasibility and effectiveness of this approach compared to the standard techniques [7].
How is adenosine absorbed?
When injected into the body, adenosine is rapidly absorbed by red blood cells and blood vessel endothelial cells and metabolized for natural uses throughout the body. In light of this adenosine should be administered by RAPID intravenous bolus so that a significant bolus of adenosine reaches the heart before it is metabolized.
Does adenosine cause chest pain?
Some side effects of adenosine administration include flushing, chest pain/tightness, brief asystole or bradycardia. Make sure that adenosine is not used for irregular, polymorphic wide-complex tachycardia and unstable VT. Use in these cases may cause clinical deterioration. Return to ACLS Drugs Main Page.
Can adenosine be used for tachycardia?
Now, adenosine can also be used for regular monomorphic wide-complex tachycardia. When given as a rapid IV bolus, adenosine slows cardiac conduction particularly affecting conduction through the AV node.
How does adenosine work?
Adenosine is a medication that is a naturally occurring nucleotide in the body. It works by blocking cyclic-AMP (CAMP) induced calcium influx into cardiac myocytes. It is used in tachyarrhythmias to delay the PR interval and slow a patient’s heart rate to a normal sinus rhythm. It is given for supraventricular tachyarrhythmias after other efforts like vagal maneuvers to slow the heart rate have failed. It is given in a characteristic single 6 mg IV rapid bolus followed by two more 12 mg IV rapid boluses if the rate fails to convert to a normal rhythm. The onset of the medication is typically seconds and resolves in about 10 seconds. Any side effects typically resolve within 1 minute of administration.
What is adenosine used for?
Adenosine is indicated for specific types of tachyarrhythmias that originate above the AV node or that use the AV node as re-entry , such as PSVT (paroxysmal supraventricular tachycardia). Atrial fibrillation, atrial flutter, and ventricular arrhythmias are not terminated by adenosine because they do not typically involve the AV node as part of the re-entrant circuit.
Can bradycardia cause a brief asystole?
It is not uncommon for patients to experience a brief (10 second) episode of bradycardia or even brief asystole. This is self-limiting and they typically return to a heart rate of a normal range quickly as this medication increases the PR interval and induces an AV block.
Does AV blocker work on tachyarrhythmias?
This medication slows AV conduction from the SA node through the AV node, which abolishes tachyarrhythmias. It does this by essentially acting as a short term calcium channel blocker inside the AV node that is induced by cyclic AMP (CAMP). This leads to a prolonged PR interval on the ECG.
What is adenosine used for?
Adenosine is a Class V Antiarrhythmic Agent used to treat Supraventricular Tachycardia (SVT). This drug has a VERY short half-life and must be administered in a particular way to work effectively.
Where to give adenosine?
So the best way to give Adenosine is in a large bore IV located at or above the antecubital but not below the wrist. If possible, you will want to push the medication with a stopcock attached to the hub of the catheter rather than through a J-loop or any other extended IV tubing.
Does adenosine block AV?
Sometimes the reduction of electrical activity at the AV no de can cause AV block.
Does adenosine slow down heart rate?
Adenosine (by itself and not as ATP) binds to purinergic receptors in vascular smooth muscle cells, causing relaxation, thus slowing the heart rate down. Adenosine also binds to the A-1 receptors in the Sinoatrial (SA) Node inhibiting the pacemaker current, again slowing the heart rate down.
What is EMS in tennis?
EMS is called to a local medical clinic for a 53 year old female complaining of weakness and palpitations. Symptoms started earlier in the day at tennis camp. The patient experienced one other episode about 2 years prior that proved to be self-limiting.
Can adenosine be used for tachycardia?
Adenosine should be used for regular tachycardias only! It can be dangerous in the setting of atrial fibrillation and Wolff-Parkinson-White Syndrome. Record a 12-lead ECG whenever possible prior to treating a narrow complex tachycardia with adenosine.
