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Every so often a patient arrives in PSVT with their only intravenous access being through a hemodialysis port.
Initial dose of adenosine should be reduced to 3 mg if administered through a central line. Remember a central line delivers the adenosine right where you need it. This recommendation is supported by the 2010 ACLS guidelines. Second and third doses should be 6 mg (instead of 12 mg).
Cases of prolonged bradycardia and severe side effects have been reported after full-dose adenosine through a central line. Other situations to consider lower doses include patients currently receiving carbamazepine or dipyridamole or in those with a transplanted heart.
References
McIntosh-Yellin NL, et al. Safety and efficacy of central intravenous bolus administration of adenosine for termination of supraventricular tachycardia. J Am Coll Cardiol 1993;22:741–5.
Chang M, et al. Adenosine dose should be less when administered through a central line. J Emerg Med 2002;22(2):195-8.
Neumar RW, et al. Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S729-S767.