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 as:

• Breath-holding while incorporating a Valsalva maneuver.
• 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 seconds.
• Assisted 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 of time.

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.

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The longer an episode of PSVT occurs, the easier it is to convert.

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