<html> <head> <meta charset="UTF-8"/> <meta name="tikaGenerated" content="true"/> <meta name="date" content="2022-03-28T23:29:27Z"/> <meta name="xmp:CreatorTool" content="Microsoft® Word for Microsoft 365"/> <meta name="Keywords" content="Neonatal Medication Guideline, Adenosine, SVT, Paroxysmal Superventricular Tachycardia"/> <meta name="subject" content="Neonatal Medication Guideline"/> <meta name="dc:creator" content="SA Maternal, Neonatal & Gynaecology Community of Practice"/> <meta name="dcterms:created" content="2022-03-28T23:29:27Z"/> <meta name="Last-Modified" content="2022-03-28T23:29:27Z"/> <meta name="dcterms:modified" content="2022-03-28T23:29:27Z"/> <meta name="title" content="Adenosine"/> <meta name="Last-Save-Date" content="2022-03-28T23:29:27Z"/> <meta name="meta:save-date" content="2022-03-28T23:29:27Z"/> <meta name="dc:title" content="Adenosine"/> <meta name="modified" content="2022-03-28T23:29:27Z"/> <meta name="cp:subject" content="Neonatal Medication Guideline"/> <meta name="Content-Type" content="application/pdf"/> <meta name="creator" content="SA Maternal, Neonatal & Gynaecology Community of Practice"/> <meta name="meta:author" content="SA Maternal, Neonatal & Gynaecology Community of Practice"/> <meta name="dc:subject" content="Neonatal Medication Guideline, Adenosine, SVT, Paroxysmal Superventricular Tachycardia"/> <meta name="meta:creation-date" content="2022-03-28T23:29:27Z"/> <meta name="created" content="Tue Mar 29 09:59:27 ACDT 2022"/> <meta name="xmpTPg:NPages" content="3"/> <meta name="Creation-Date" content="2022-03-28T23:29:27Z"/> <meta name="meta:keyword" content="Neonatal Medication Guideline, Adenosine, SVT, Paroxysmal Superventricular Tachycardia"/> <meta name="Author" content="SA Maternal, Neonatal & Gynaecology Community of Practice"/> <meta name="producer" content="Microsoft® Word for Microsoft 365"/> </head> <body> <pre> South Australian Neonatal Medication Guidelines Adenosine 6mg/2mL injection Department for Health and Wellbeing, Government of South Australia. All rights reserved. INFORMAL COPY WHEN PRINTED Page 1 of 3 OFFICIAL Note: This guideline provides advice of a general nature. This statewide guideline has been prepared to promote and facilitate standardisation and consistency of practice, using a multidisciplinary approach. The guideline is based on a review of published evidence and expert opinion. Information in this statewide guideline is current at the time of publication. SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not sponsor, approve or endorse materials on such links. Health practitioners in the South Australian public health sector are expected to review specific details of each patient and professionally assess the applicability of the relevant guideline to that clinical situation. If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful confidential discussion. This includes: The use of interpreter services where necessary, Advising consumers of their choice and ensuring informed consent is obtained, Providing care within scope of practice, meeting all legislative requirements and maintaining standards of professional conduct, and Documenting all care in accordance with mandatory and local requirements This is a High Risk Medication An overdose can be rapidly fatal. Dose and Indications 1mg = 1000micrograms Write all doses in micrograms To Revert Paroxysmal Supraventricular Tachycardia (SVT) Intravenous 100micrograms/kg/dose initially, increasing by 50-100 micrograms/kg/dose increments (to a maximum of 300micrograms/kg/dose) every 1 to 2 minutes until return of sinus rhythm. ? All SVT requires cardiologist consultation, but this should not delay emergency management ? SVT not responsive to a dose of 300microg/kg, may be managed with larger doses of up to 500microg/kg or other antiarrhythmics after consultation with a paediatric cardiologist ? SVT with shock will require prompt DC cardioversion if difficult vascular access delays adenosine administration South Australian Neonatal Medication Guidelines Adenosine 6mg/2mL injection INFORMAL COPY WHEN PRINTED Page 2 of 3 OFFICIAL Preparation and Administration Intravenous Withdraw 1mL(3mg) from a 6mg/2mL adenosine injection and add to 2mL of compatible fluid (total volume 3mL) and shake gently to mix. The resulting solution contains 1000micrograms/mL adenosine. Dose 100 micrograms 150 micrograms 200 micrograms 250 micrograms 300 micrograms 350 micrograms Volume 0.1mL 0.15mL 0.2mL 0.25mL 0.3mL 0.35mL For small volumes (e.g., less than 0.5mL) dilute further with 1 to 2mL of sodium chloride 0.9% Solution must be clear at time of administration. Administer by rapid intravenous bolus followed by rapid 0.9% sodium chloride flush. Give by large peripheral vein or central vein, via the most proximal IV site possible. To administer: ? Withdraw the dose required from the diluted solution above ? Prime a three-way tap and short extension tube with 0.9% sodium chloride flush and leave connected ? Attach adenosine dose syringe to other port on three-way tap ? Administer adenosine by rapid IV injection over 1 to 2 seconds ? Follow instantaneously with a rapid flush over 1 to 2 seconds of 3 - 5mL 0.9% sodium chloride via other port on three-way tap. Do not refrigerate, crystallisation will occur. Compatible Fluids Glucose 5%, sodium chloride 0.9% Adverse Effects Adverse effects resolve rapidly on stopping treatment due to its short duration of action. Common Flushing, dyspnoea Infrequent Transient arrhythmias, hypotension South Australian Neonatal Medication Guidelines Adenosine 6mg/2mL injection INFORMAL COPY WHEN PRINTED Page 3 of 3 OFFICIAL Monitoring ? Adenosine should only be used when facilities for cardiac monitoring and cardiorespiratory resuscitation exist. ? Continuous electrocardiogram (ECG) is required during administration ? Blood pressure Practice Points ? Caffeine diminishes adenosine s affect by competitive antagonism. Larger doses may be required in patients receiving caffeine ? Doses must be given by rapid intravenous push. Inject dose as close to intravenous site as possible with sufficient flush volume to ensure the bolus dose is administered to patient (and not still contained in the line) ? Adenosine has a very short duration of effect (half-life of less than 10 seconds) making it necessary to give this agent as a rapid bolus ? Diluting the ampoule assists with drawing up an accurate dose. Document Ownership & History Developed by: SA Maternal, Neonatal & Gynaecology Community of Practice Contact: Health.NeoMed@sa.gov.au Endorsed by: Commissioning and Performance, SA Health Next review due: 28/03/2027 ISBN number: 978-1-76083-495-1 CGSQ reference: NMG 016 Policy history: Is this a new policy (V1)? N Does this policy amend or update and existing policy? Y If so, which version? V 2.0 Does this policy replace another policy with a different title? N If so, which policy (title)? Approval Date Version Who approved New/Revised Version Reason for Change 28/3/2022 V3.0 Domain Custodian, Clinical Governance, Safety and Quality Formal Review 4/2017 V2.0 SA Health Safety and Quality Strategic Governance Committee Complete review 11/2012 V1.0 SA Maternal & Neonatal Clinical Network Original SA Maternal & Neonatal Clinical Network approved version. </pre> </body> </html>