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When caring for a child with supraventricular tachycardia, you should consider performing vagal maneuvers, according to new guidelines for pediatric advanced life support (PALS) from the Dallas-based American Heart Association (AHA).
The recommended technique is to apply a glove filled with crushed ice and water to the face, says Michele Wolff, RN, MSN, CCRN, professor of nursing at Saddleback College in Mission Viejo, CA. Take care to apply the ice water mixture to the face without obstructing ventilation, she cautions. "If a child is hemodynamically unstable, synchronized cardioversion remains the first-line treatment," Wolff notes.
Vagal maneuvers have been shown to successfully convert a supraventricular tachycardia rhythm, which is the most common nonarrest arrhythmia during childhood, says Wolff.
The guidelines recommend the use of synchronized cardioversion and/or adenosine for children with supraventricular tachycardia and poor perfusion, notes Wolff. "It is noted that the success rates with vagal maneuvers may vary based on the underlying condition, child’s age, and ability to cooperate."
If no contraindications are present, all patients with superventricular tachycardia should be initially treated with vagal maneuvers or adenosine, calcium channel blockers such as verapamil or diltiazem, beta blockers, or digoxin, says Barbara Weintraub, RN, MPH, MSN, pediatric critical care nurse practitioner at Northwest Community Hospital in Arlington Heights, IL. "Electrical cardioversion can be utilized when atrioventricular nodal agents are unsuccessful."
Many pediatric care centers and physicians have used vagal maneuvers in children with superventricular tachycardia, Wolff emphasizes. "This new AHA recommendation helps bridge the gap between PALS guidelines and reality that is sometimes experienced when nurses are caring for ill children."