PROCEDURE FOR EPINEPHRINE ADMINISTRATION IN CCTC
Under Medical Directive

Purpose:

Epinephrine is a sympathomimetic which stimulates both alpha and beta adrenergic receptors. Alpha adrenergic receptors will cause peripheral vasoconstriction which leads to improved coronary and cerebral perfusion pressure. Beta effects will increase strength of myocardial contraction, increase automaticity and increase the electrical activity in the myocardium.
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. Approval
  3. Continue defibrillation
  4. Hand Hygiene
  5. Prepare infusion
  1. Notify physician
  2. Monitor for side effects
  3. Document
  4. Order requirement

PROCEDURE

RATIONALE FOR PROCEDURE

 1.

Identify Life-Threatening Rhythm

The nurse identifies a life-threatening arrhythmia that would respond to epinephrine:
• Ventricular Ffibrillation (VF)
• pulseless Ventricular Tachycardia (VT) that is unresponsive to initial defibrillation attempts

 1.

Epinephrine stimulates vasoconstriction, increasing systemic vascular resistance which may improve coronary and cerebral perfusion pressure.

 2.

Approval

A nurse may administer 1 mg of epinephrine IV direct as part of the defibrillation procedure. (Note: 2mg of Epinephrine may be given via the ETT if there is no venous access).

 2.

Epinephrine 1 mg provides alpha dosage.

 3.

Reassess Rhythm

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

 3.

VF rarely converts without an application of direct current.

    4. Hand Hygiene        4.. 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.

  5. 

Administer Drug

A nurse may administer a second dose of epinephrine 1 mg IV direct as part of the defibrillation procedure. (Note: 2mg of Epinephrine may be given via the ETT if there is no venous access).

 5 .

Epinephrine is metabolized rapidly by the liver and the arrhythmia may require a second dose.

6. 

Notify Physician

Notify the critical care physician.

 6.

Further treatment may be necessary.

7.

Monitor for Side Effects

Monitor for side effects of epinephrine or reoccurrence of VT/VF.

7.



Epinephrine increases myocardial oxygen consumption and can precipitate or worsen myocardial ischemia.

8.

Document

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

 8. 

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

9.

Order Requirement

The medical directive is the physician's order.

 9.

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:March 24, 2010, Reviewed: September 29, 2014 (B. Morgan).

LHSCHealth Professionals

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