The Usage Of Two 3 Way Stopcocks For Intravenous Administration Of Adenosine
K V Nibhanipudi
Citation
K V Nibhanipudi. The Usage Of Two 3 Way Stopcocks For Intravenous Administration Of Adenosine. The Internet Journal of Emergency and Intensive Care Medicine. 2014 Volume 15 Number 1.
DOI: 10.5580/IJEICM.22937
Abstract
Objective
To determine the efficacy of the usage of two 3-way stopcocks for the intravenous administration of adenosine compared to the traditional two-syringe technique
Introduction
Adenosine is used for the treatment of Paroxysmal Supra ventricular Tachycardia. Adenosine has to be administered as rapidly as possible followed by the normal saline flush.
Methods:
Design
Prospective in-vitro study.
Setting:
Pediatric Emergency room.
Participants:
46 volunteers were asked to participate in the study.
Outcome measure:
Timing difference between the two methodologies of administration.
Methodology
The volunteers (46) were asked to administer both normal saline and adenosine both by the traditional method and also by two 3 way stopcock method.. For the traditional two syringe method, volunteer was asked to first discontinue the IV and then attach syringe containing adenosine (3mg/1ml) to be administered through the angeocath as rapidly as possible and later asked to remove the syringe from the hub end of the catheter and volunteer is asked to maintain pressure with the thumb over the hub end of the catheter and insert syringe containing saline (3cc) and asked to push the syringe as rapidly as possible The time was noted from the intravenous discontinuation to the finish of the normal saline flush and intravenous line connected. In the two 3 way stopcock method, volunteer is asked to first turn the lever of the first stopcock to the IV line so that IV line gets occluded and keep open the aperture containing adenosine. Push the syringe containing adenosine (3mg/1cc) as rapidly as possible and then turn the lever to open the normal IV line was occluded until NS push was completed and IV line restarted.
Results
46 volunteers were asked to participate in the study.26 of the 46 volunteers were physicians and other 20 were registered nurses Using the traditional two-way technique the time was 13.456 seconds. (Range 7-17 seconds). ... In the two 3-way stopcock method the mean time was 7.424 seconds (range 4--9 seconds). The reduction of time in the mean duration for the two 3-way stopcock method was 6.0217 seconds favoring the two 3-way stopcock method. Student T-test was applied to the paired data of timings taken by the traditional twos yringe technique and the two 3-way stopcock method. The resulting p-value is <0.0001 showing a highly statistically significant improvement with the new two 3-way stop-cock method.
Conclusion
In summary based on the analysis of the data the two 3-way stopcock technique is more effective compared to the traditional two syringe technique. The evidence suggests that the two 3-way stopcock method can be used for any emergent situation when rapid administration of medication required being closer to the IV line.
Introduction
Adenosine in used for the treatment of Paroxysmal Supraventricular tachycardia. Adenosine has to be administered as rapidly as possible followed by the normal saline flush. A review of the literature showed no mention of the usage of the two 3 way stopcock technique for intravenous administration of adenosine
Introduction
Adenosine in used for the treatment of Paroxysmal Supraventricular tachycardia. Adenosine has to be administered as rapidly as possible followed by the normal saline flush. A review of the literature showed no mention of the usage of the two 3 way stopcock technique for intravenous administration of adenosine
Methodology
It is a prospective in-vitro study. (IRB informed that there is no need to obtain the consents from the participants).
Setting: Pediatric Emergency room.
Selection of participants:
46 volunteers (physicians/nurses) were asked to participate in the study of intravenous administration of adenosine followed by the normal saline flush using by the traditional method and also by the two 3-way stopcock method using the apparatus designed by the author. All the participants were explained and trained the procedure to be done by both methods. All the participants have performed in the said manner. Out of 46 participants 26 were physicians, 8 of them were attending physicians and the rest are resident physicians. The remaining 20 nurses are licensed registered nurses. All the physicians and nurses are ACLS and BLS certified.
Methods:
The apparatus designed by the author has been used. Thin rubber tubes (usually used as tourniquet) were used as venous lines. One end of the rubber tube was connected to a reservoir to collect the fluid and the other end is tied to a small pole in a tight manner. To each rubber tube a 22 gauge angeocath being introduced and fixed with an adhesive tape. 2 syringes were used for both the methods.
One marked as normal saline and the other as adenosine. Rubber tubing #1 was used for the traditional method and the rubber tubing #2 was used for the two 3way Stop cock method. For the rubber tubing #1 intravenous line is directly connected to the hub end of the catheter. Rubber tubing #2 was used for the two 3 way stopcock technique as depicted. One prong of the first 3 way stopcock was attached to the end of the intravenous line and the other prong was attached to the hub end of the catheter. The 3rd prong of the first 3 way stopcock was attached to the one prong of the 2nd 3way stopcock. For the other two prongs ofthe second 3 way stopcock attached syringes containing adenosine and normal saline respectively.
The volunteers were asked to administer both normal saline and adenosine in both the tubings. For the traditional method, the volunteer was asked first to discontinue the intravenous line and then attach the syringe containing adenosine (1cc/3mg) and asked to administer as rapidly as possible and later asked to remove the syringe from the hub end of the catheter and volunteer was asked to maintain pressure with the thumb over the hub end of the catheter and then insert syringe contain normal saline (3cc) and asked to push the syringe as rapidly as possible. The time was noted from the intravenous discontinuation to the finish of the normal saline flush and intravenous line connected. In the two 3-way stopcock method, volunteer was asked to first turn the lever of the first stopcock to the intravenous line so that the intravenous line got occluded and kept open the aperture containing adenosine. The volunteer was asked later to push the syringe attached to one prong of the 2nd 3 way stopcock containing adenosine (1cc/3mg).The volunteer was later asked to turn the lever of 2nd 3 way stopcock towards the prong containing adenosine, so that the opening containing adenosine got occluded and opened the other prong containing normal saline and push the syringe containing normal saline.(3cc) as rapidly as possible. The timing was noted from the occlusion of intravenous line to the finish of normal saline flush and reopen the lever of first 3way stopcock to open the intravenous line.
Method of Measurement:
The time was measured from the intravenous line occluded until normal saline flush completed and intravenous line restarted using the stop watch to measure the time in seconds for both for both the techniques.
Results
46 volunteers were asked to participate in the study. 26 of the 46 volunteers were physicians and other 20 were registered nurses. Using the traditional method the time was 13.456 seconds (range 7-17 seconds). In the two 3way stopcock method, the mean time was 7.424 seconds (range 4-9 seconds). The reduction of the time in the mean duration for the two 3 way stop cock method was 6.0217 seconds favoring the two 3-way stopcock method. All the participants took a longer time to push adenosine by traditional method compared to two 3-way stop cock method.
However there is not even one instance where traditional method is faster compared to two 3-way stop-cock method performed by the same individual. However there may be individual variation in the administration of adenosine.
Data analysis:
Student t-Test was applied to the paired data of timings taken by the traditional technique and the two 3-way stop stopcock method. The resulting p-value was <0.0001 showing a highly statistically significant improvement with the new two 3-way stopcock method.
Discussion
The two 3 way stopcock method does not require the removal of the intravenous line as it can be occluded with the lever of the first 3 way stopcock. By simply adjusting the lever of the 2nd 3 way stopcock adenosine and normal saline can be administered as rapidly as possible and the intravenous line can be continued by adjusting the lever of the first 3 way stopcock. Our study demonstrates the ultimate reduction in the timing of administration of adenosine. Other advantages of the two 3-way stopcock method include the elimination of exposure to blood.
Theoretically, it also minimizes the risk of infections because there is no need to change the Syringes.
Limitations:
To study the risk of infection with two 3-way stopcocks is limited due to the fact that there are no real veins but thin rubber tubes.
Conclusions
In summary based on the analysis of the data the two 3-way stopcock technique was more effective compared to the traditional method. The evidence suggested that the two 3-way stop-cock method can be used for any emergent situation where rapid administration of medication required being closer to the intravenous line.