PROCEDURE FOR LIDOCAINE ADMINISTRATION IN CCTC
Under Medical Directive

Purpose:

Lidocaine is a Group IB antiarrhythmic agent that reduces the irritability of the myocardium by decreasing repolarization (decreasing QT interval).

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

1. Identify life-threatening rhythm
2. Administration
3. Continue defibrillation
4. Hand Hygiene
5. Prepare infusion
   

6. Notify physician
7. Monitor for side effects
8. Document
9. Order requirement

PROCEDURE

 1.

Identify Life-Threatening Rhythm

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

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

 1.

Lidocaine can terminate a re-entry ventricular arrhythmia by decreasing ventricular excitability and increasing stimulation threshold of the ventricle.

Lidocaine can be an alternative for these life-threatening arrhythmias if the patient has a:
a) known allergy to Amiodarone
a) documented prolonged QT interval

 2.

Administration

A nurse may administer 1 mg/kg of lidocaine once as part of the defibrillation procedure under medical directive. (Note: 1.5mg of Lidocaine may be given via the ETT if there is no venous access).

 2.

Lidocaine acts directly on the myocardial tissues to decrease excitability in the ventricles.

 3.

Continue Defibrillation Protocol

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

 3.

VF rarely converts without an application of direct current.

 5.

Prepare Infusion

If treatment is successful, the nurse may initiate a lidocaine infusion of 2 gm/500cc D5W at 2 mg/min (30cc/hr) per defibrillation procedure under medical directive.

 5. 

Lidocaine infusion maintains a therapeutic level to prevent recurrent VT.

 6.

Notify Physician

Notify the critical care physician.

 6.

Further treatment may be necessary.

7.

Monitor for Side Effects

Monitor for side effects of lidocaine.

 7.

Clinical signs and symptoms of toxicity include drowsiness, disorientation, parasthesthesias, muscle twitching, agitation, seizures and hypotension.

8.

Document

The nurse documents administration and effect of lidocaine 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 per medical directive.