Adenosine

 

Indications

• Stable narrow-complex PSVT
• May consider for unstable narrow-complex reentry tachycardia while preparing for synchronized cardioversion
• Wide-complex regular tachycardia thought to be or previously defined to be reentry SVT
• Does NOT convert atrial fibrillation, atrial flutter or VT

 

Contraindications

• Known allergy, poison/drug induced tachycardia or second- or third-degree heart block

 

Precautions

• Side effects include: flushing, chest pain or tightness, brief periods of Asystole or bradycardia, ventricular ectopy
• This drug is less effective in patients taking theophylline or caffeine; reduce dose to 3mg in patients receiving dipyridamole or carbamazepine
• If administered for wide-complex tachycardia/VT, may cause deterioration (including hypotension)
• Transient periods of sinus bradycardia and ventricular ectopy are common after termination of SVT
• Safe and effective in pregnancy

 

IV Rapid Push

• Place patient in mild reverse Trendelenburg position before administration of drug
• Initial bolus of 6mg given rapidly over 1 – 3 seconds followed by NS bolus of 20mL; then elevate the extremity
• A second dose (12mg) can be given in 1 – 2 minutes if needed
• A third dose (12mg) can be given in 1 – 2 minutes if needed

 

Injection Technique

• Record rhythm strip during administration
• Drawn up adenosine dose and flush in 2 separate syringes
• Attach both syringes to the IV injection port closer to the patient
• Clamp IV tubing above injection port
• Push IV adenosine as quickly as possible (1 – 3 seconds)
• While maintaining pressure on adenosine plunger, push NS flush as rapidly as possible after adenosine
• Unclamp IV tubing