PROCEDURE FOR AMIODARONE ADMINISTRATION IN CCTC
Under Medical Directive

Purpose:

Amiodarone is a Class III antiarrhythmic that lengthens the action potential and blocks myocardial potassium channels. This results in a slowing of the electrical conduction and lengthening of the refractory period.

Administration of this drug can be performed by CCTC nursing staff who are approved in the administration of life saving drugs.

  1. Identify life-threatening rhythm
  2. Rule out contraindications
  3. Administration
  4. Prepares for defibrillation
  5. Hand Hygiene
  1. Prepare Infusion
  2. Notify physician
  3. Monitor for side effects
  4. Document
  5. Order requirement

PROCEDURE

RATIONALE FOR PROCEDURE

 1.

Identify Life-Threatening Rhythm

The nurse identifies a life-threatening arrhythmia that would respond to amiodarone:
• Ventricular Fibrillation (VF)
• pulseless Ventricular Tachycardia (VT)

Amiodarone should be considered as a first-line drug for these rhythms.

 1.

Amiodarone lengthens repolarization, slows conduction and reduces activity through accessory pathways.

 2.

Rule Our Contraindications

If contraindicated, lidocaine is the alternative antiarrhythmic.

 2.

Contraindications include:
• known allergy to amiodarone
• prolonged QT interval.

 3.

Administration

A CCTC nurse may administer a one time dose of Amiodarone 300 mg IV direct as part of the procedure for defibrillation under medical directive.

 3.

Amiodarone in conjunction with defibrillation, may convert life-threatening arrhythmias.

 4.

Continue Defibrillation Protocol

Reassess rhythms and if VF/VT present, continue to follow defibrillation algorithm.

 4.

VF rarely converts without an application of direct current.

 5.

Hand Hygiene

 5

In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions.

 6.

Prepare Infusion

If treatment is successful, the approved nurse may initiate an amiodarone infusion of 900 mg/500cc D5W at 50 mg/hr.

NB: Amiodarone infusions must be run with a 0.2 micron filter IV set.

 6

Amiodarone infusion maintains a therapeutic level to prevent recurrent VT.

 

 

Per LHSC policy on running an infusion of Amiodarone.

 7.

Notify Physician

Notify the critical care physician.

 7.

Further treatment may be necessary.

8.

Monitor for Side Effects

Monitor for side effects of amiodarone.

 8.



May cause hypotension and prolonged QT interval leading to Torsades de Pointes.

9.

Document

The nurse documents administration and effect of amiodarone in the clinical record and cardiac arrest record.

 9.

The CNO identifies the nurse as competent to perform this skill and accountable for practice under a medical directive. Documentation provides evidence of clinical decision making and activation of protocol driven practice.

10.

Order Requirement

The medical directive is the physician's order.

 10.

This skill delegates to the nurse the ability to make independent decisions and to implement actions according to protocol guidelines under medical directive.

References:

American Heart Association. (2000). Guidelines 2000 for cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 6: Advanced cardiovascular life support: 7D. The American Heart in collaboration with the International Liaison Committee on Resuscitation. Circulation, August 22; 102 (8 Supp).

Field, J.M., Hazinski, M. & Gilmore, D (Eds). (2006). Handbook of Emergency Cardiovascular Care for Healthcare Providers. American Heart Association.

Hazinksi, M., Chameides, L., Elling, B. & Hemphill, R. (2005-2006). Highlights of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Currents in Emergency Cardiovascular Care, Vol 16, 4, 1-28.

Developed by:
Judy Hackett RN BScN CCTC
Clinical Educator, CCTC
August 14, 2006
October 2006

 

Last Update:April 6, 2010, September 29, 2014 (B.Morgan)

LHSCHealth Professionals

Last Updated September 29, 2014 | © 2007, LHSC, London Ontario Canada