How to best administer Adenosine for SVT? Single syringe? 3 Way Stopcock? Two Syringe?

The American Heart Association 2015 guidelines for Adult Advanced Cardiac Life Support recommends adenosine in nonhypotensive patients in regular narrow‐complex SVT. Adenosine is an endogenous purine nucleoside that blocks atrioventricular nodal conduction via the A1 receptors in the cardiac tissue. These in turn act on Gi‐cAMP to stimulate potassium channels yielding hyperpolarization of cardiac myocytes thus returning the heart to a normal sinus rhythm (NSR).

The pharmacokinetic profile of adenosine makes it an ideal agent to treat SVT. With a rapid onset and a half‐life less than 10 seconds, cardioversion can be performed quickly with limited adverse effects. Due to these unique kinetics, a large‐volume flush of saline is concomitantly administered to ensure adequate delivery to the myocardium. Adenosine is commonly administered as a 6‐mg rapid intravenous bolus over 1 to 2 seconds followed by a rapid 20‐mL saline flush.

Studies:
Single‐syringe Administration of Diluted Adenosine
Marc McDowell PharmD Robert Mokszycki PharmD Allyson Greenberg PharmD Mary Hormese PharmD Nadine Lomotan PharmD Neal Lyons PharmD
First published: 30 October 2019
https://doi.org/10.1111/acem.13879
https://onlinelibrary.wiley.com/doi/10.1111/acem.13879

Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial
Andrew Appelboam, FRCEM Adam Reuben, FRCEM Clifford Mann, FRCEM James Gagg, FRCEM Prof Paul Ewings, PhD Andrew Barton, MSc
Open Access Published:August 24, 2015
DOI: https://doi.org/10.1016/S0140-6736(15)61485-4
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61485-4/fulltext
https://www.youtube.com/watchv=8DIRiOA_OsA&feature=emb_title&ab_channel=TheLancet

Stability of undiluted and diluted adenosine at three temperatures in syringes and bags
Vaishali A. Ketkar, William M. Kolling, Nahathai Nardviriyakul, Kirk Van Der Kamp, Dale Eric Wurster, Ph.D. American Journal of Health-System Pharmacy, Volume 55, Issue 5, 1 March 1998, Pages 466–470
https://doi.org/10.1093/ajhp/55.5.466 Published: 01 March 1998
https://academic.oup.com/ajhp/article-abstract/55/5/466/5156026?redirectedFrom=fulltext

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