Adenosine IV site

[lilmedic]

Hello everyone,

I was wondering if anyone has come across any research regarding IV sites and adenosine.

I recently had a patient in a PSVT who's only IV site was an 18g in his dorsal metacarpal vein. He was symptomatic with a BP of 84/52, SOB (no pulmonary edema), complaining of chest pain and his 12-lead revealed anterolateral ST depression. After an unsuccessful Valsalva maneuver, I elected to treat with adenosine (6mg IV followed by a 20cc flush, and then 12mg approximately 2 min later) which was also unsuccessful. While I was synchronizing my monitor and preparing to sedate him, he converted........

Does anyone have an idea what the infusion time difference is in the antecubital fossa vs dorsal metacarpal?

 

[Carlos Danger]

How long does it take blood to flow from the hand to the elbow? 1 second? 1.5 seconds? I don't know. I doubt there is any discernible difference between between a drug injected in the hand vs. one injected in the antecubital fossa. Especially if your IV is running briskly and the drug is flushed with 10cc or so.

 

[NomadicMedic]

Yes. Converted on the 12 with a dorsal 20ga.

Also, simply putting pads on someone can cause them to convert. I like the think it's the fear of getting lit up.

 

[VFlutter]

I think the flush is more important than the injection site necessarily. I usually use a 3 way stopcock so i can immediately flush the line without fumbling around.

I doubt it was the Adenosine that caused him to convert. The half life of Adenosine is seconds.

 

[TransportJockey]

Not sure about IV site, but I know a tibial IO will do allow a conversion w/ adenocard

 

[Alan L Serve]

It takes 60 seconds or less for a red blood cell to go from one spot and make its way through the back and return to that same spot.

Sit, Spot, sit. See Spot run. Run Spot run.

 

[Summit]

I've done it from a hand of course is prefer proximal or better yet central

 

[EthanMD]

I would've went straight to cardioversion. Those findings show the patient to be severely symptomatic.

 

[TransportJockey]

I would've went straight to cardioversion. Those findings show the patient to be severely symptomatic.

For me it would have really depended on his LOC. That's generally what I use to help guide my drugs vs electricity decision tree. But I'm also not hte OP...