Critical Care Trauma Centre

AMIODARONE ADMINISTRATION BY MEDICAL DIRECTIVE IN CCTC

 

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.

A certified nurse in critical care may administer this drug by Medical Directive. 

Ensure that patient and health care provider safety standards are met during this procedure including:

  • Risk assessment and appropriate PPE
  • 4 Moments of Hand Hygiene
  • Procedural Safety Pause is performed
  • Two patient identification
  • Safe patient handling practices
  • Biomedical waste disposal policies
  • Electrical safety
  1. Identify life-threatening rhythm
  2. Rule out contraindications
  3. Administration
  4. Prepares for defibrillation
  5. Prepare Infusion
  1. Notify physician
  2. Monitor for side effects
  3. Document
  4. Order requirement

PROCEDURE

 1.

Identify Life-Threatening Rhythm

A certified critical care nurse may administer amiodarone by Medical Directive in the following circumstances:

•  Ventricular Fibrillation (VF)
•  Pulseless Ventricular Tachycardia (VT)

When amiodarone is indicated for other circumstances, a medical order is required.  Amiodarone is usually the first line agent for VF and VT unless there is a contraindication. 

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

 2.

Rule Our Contraindications

If contraindicated, lidocaine is the alternative antiarrhythmic.
 

Contraindications include:

  • Complete heart block without a working pacemaker
  • Known allergy to amiodarone
  • Prolonged QT interval.

 3.

Administration

A CCTC nurse may administer a dose of Amiodarone 300 mg by Medical Directive.

  1. Draw amiodarone 300 mg (6 mL) into a 30 ml syringe.
  2. Add 24 mL from a bag of  D5W to create a final solution of 300 mg in 30 mL.
  3. You do not need a filter for the bolus dose.  
  4. Administer IV direct..

 

A CCTC nurse may administer a second dose of 150 mg by Medical Directive if no effect in 5 minutes.

To administer a 150 mg bolus:

  1. Draw amiodarone 150 mg (3 mL) into a 30 ml syringe.
  2. Add 27 mL from a bag of  D5W to create a final solution of 150 mg in 30 mL.
  3. You do not need a filter for the bolus dose.  
  4. Administer IV direct..

 

 

 4.

Continue Defibrillation Protocol

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

VF rarely converts without an application of direct current.

 5.

Prepare Infusion

If treatment is successful, an amiodarone infusion may be indicated. An amiodarone infusion  requires an order by the physician (ie it is not covered under the critical care Medical Directive).

Premixed bags of amiodarone 900 mg/500 ml D5W or 450 mg/250 ml are kept in the medication fridge. 

Continuous Infusion:

  • 900 mg over 24 hours (run at 50 mg per hour)
 

Amiodarone infusions require a 0.2 micron filter IV set.

An amiodarone infusion is used to maintain a therapeutic level for patients who are at risk for recurrent VT.

 6.

Notify Physician

Notify the critical care physician as further treatment or investigation may be indicated.
 

7.

Monitor for Side Effects

Monitor QT interval and signs of other side effects of amiodarone.

Amiodarone may cause hypotension. It can also prolong the QT interval and cause Torsades de Pointes. This risk is increased with prolonged use or when other QT prolonging agents are used.

9.

Document

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

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.

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. 2015 & 2018 Integrated ACLS Guidelines: 
https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-7-adult-advanced-cardiovascular-life-support/



Developed by:
Judy Hackett RN BScN CCTC

Clinical Educator, CCTC
August 14, 2006
Last Update:November 5, 2018 (B.Morgan)