Managing SVT with a single syringe Adenosine
You are working a busy post-Thanksgiving holiday shift when EMS brings you a 46-year-old man who was complaining of palpitations. His only history is Hypertension which he controls with diet and exercise. However, he admits to consuming large amounts of alcohol during dinner with his family. You hear the loud ‘beeps’ of the monitor which shows a heart rate in the 160’s. After confirming that the narrow rhythm printed on the EKG is indeed Supraventricular Tachycardia, you prepare the team in the room that you plan on administering Adenosine. The problem of pushing adenosine through a running IV line, followed by two 10-mL saline flushes is that it takes precious time to switch syringes. Even if utilizing the stopcock method, nurse unfamiliarity with how to maneuver the port from OFF to ON may lead to some confusion. Enter the singly syringe method: In fact, this method was recently studied in a non-blinded prospective study in which clinicians could choose a single-syringe (SS) (n=26), or two-syringe (TS) with stopcock (n=27) method of giving adenosine. For the primary outcome of conversion to NSR with one dose, the SS group was non-inferior to the TS group; 73.1% (95%CI 0.55 to 0.91) to 40.7% (95%CI 0.21 to 0.61; noninferiority, p = 0.0176). There was one extravasation event in the TS group and none in the SS group. Of course, this study had some limitations. It was a small unblinded pilot study and did not meet its enrollment goal of 75 patients. It did show, however, that the single-syringe method of adenosine is at least as effective as the traditional techniques. Maybe you should try this on your next SVT patient. Reference: |
