Treatment of PSVT
Treatment of a child with PSVT will depend on a
number of factors which include:
- known history of PSVT.
- cardiovascular stability of the patient
with this episode.
- underlying medical or cardiac conditions.
- the length of time this tachyarrhythmia
has been occurring.
There is minimal special training
required for the lay person to provide emergency treatment to a
pediatric patient with PSVT. Either by themselves, or with the
assistance of a caregiver (parent, school nurse, sibling, etc.)
children with a known history of PSVT are able to convert their
own episodes 90% of the time with a variety of home remedies such
- Breath-holding while incorporating a
- Performing a Valsalva maneuver in the
supine position, which may be more successful than if the
child is standing.
- Physically induced gagging.
- Coughing, retching, or vomiting.
- Hand stand or head stand held for 30
deep bending. (Click here to view
a video demonstration.)
- While sitting, (Click
here to view a video demonstration.)
child may bend over as if to pick up
something off of the floor.
- Stimulation of the diving reflex (Click
here to view a video demonstration.) by immersion of the child's face in a pan of ice
water (3-4 degrees Celsius) for 5 seconds. In a study
conducted by Aydin, Baysal, Kucukoduk, Cetinkaya, and
Yaman (1995), this was found to be effective in restoring
sinus rhythm 96% of the time.
- If this technique is used on infants,
however, it should be performed with great caution under
close cardiac monitoring, as marked bradycardia may occur
(Gewitz, M., Vetter, V., 1993).
It is important for the child to
immediately begin trying these maneuvers, as the longer the PSVT
persists, the more difficult it becomes to convert.
- These maneuvers are easy, safe, often
effective, and as long as the child remains in a well
compensated and stable state, they can be repeated
many times until the rhythm has converted.
- If a well compensated child has an episode
of PSVT that persists for 30 minutes, a visit to an
emergency department should be arranged.
Immediate arrangements to an emergency
department should be made for all pediatric patients who have no
prior history of SVT, patients with a known PSVT history who are
symptomatic, or patients who are hemodynamically unstable.
- Emergency medical transport services with
Advanced Cardiac Life Support (ACLS) capabilities should
be considered for the transport of these patients.
- If ACLS service is available, immediate
treatment of this tachyarrhythmia will begin in the
pre-hospital setting and patient stabilization will
ultimately occur in a much shorter duration of time.
While caring for
a pediatric patient with PSVT, the nurse must utilize precise
organizational and communication skills.
- Constant care must be utilized so as not
to induce excessive fear or anxiety in the patient or
parent as a result of this urgent situation.
- The nurse must be able to think clearly,
move swiftly, and perform many tasks in a limited amount
Primary assesssment and care of the
patient will direct necessary attention to the patient's airway,
breathing status and circulatory status. Continuous cardiac
monitoring and a 12 lead EKG should be in place, and will later
provide crucial diagnostic information. Proximal intravenous (IV)
access should be attained, preferably in the antecubital fossa.
an episode of PSVT occurs, the easier it is to convert.
TRUE or FALSE