Tip of the Month
Perform vagal maneuvers for children with SVT
New guidelines recommend vagal maneuvers for children with supraventricular tachycardia (SVT), so you’ll need to be familiar with this technique, reports Barbara Weintraub, RN, MPH, MSN, pediatric critical care nurse practitioner at Northwest Community Hospital in Arlington Heights, IL.
Although vagal maneuvers never were formally recommended for pediatric SVT previously, they have been used in pediatric ED for years with success, Weintraub notes. However, new guidelines from the Dallas-based American Heart Association for pediatric advanced life support (PALS) include the option for initial treatment of stable SVT with vagal maneuvers, she explains. (For more information on the new PALS guidelines, see ED Nursing, February 2001, pp. 45 and 50.) Vagal maneuvers can be performed in a variety of ways, depending on the age, developmental level, and ability to cooperate of the child, Weintraub says. Here are three:
- having the child hold his or her breath and visualize blowing up a balloon;
- having a child take a deep breath and cough;
- suddenly plunging the child’s hands and face into ice water.
All these methods are acceptable, says Weintraub. "The child should be on a cardiac monitor when this is done, and nurses should watch for a slowing of the rhythm with a return to a normal rate," she adds. "If acute or prolonged bradycardia develops, alert the physician and stop the vagal maneuvers."
Vagal maneuvers are only indicated in patients who are stable with normal level of consciousness and blood pressure within normal limits, Weintraub cautions. "Patients who are unstable with decreased level of consciousness, low blood pressure, extreme pallor, cyanosis, or diaphoresis should receive immediate synchronized cardioversion," she says.
[Editor’s note: For more information about vagal maneuvers, contact Barbara Weintraub, RN, MPH, MSN, Northwest Community Hospital, 800 W. Central Road, Arlington Heights, IL 60005. Telephone: (847) 618-5432. Fax: (847) 618-5419. E-mail: [email protected].]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content