AACN endorses scientific statement on prevention of TdP

The American Association of Critical-Care Nurses (AACN) recently endorsed "Prevention of Torsades de Pointes (TdP) in Hospital Settings," a scientific statement from the American Heart Association, Dallas, and American College of Cardiology Foundation, Washington, D.C.

TdP, a rare heart rhythm associated with a drop in blood pressure, can induce fainting or lead to ventricular fibrillation, a trigger for sudden cardiac arrest, the statement reports. TdP risk factors include heart rhythm abnormalities, heart disease, older age, female gender, use of diuretics, kidney problems and low blood levels of calcium, potassium or magnesium, it adds.

According to the statement, medications that prolong the heart's Q-T interval — the electrocardiogram (ECG) measurement that indicates time for electrical activation and inactivation of the lower chambers of the heart — increase the risk of TdP. These medications include those given intravenously, such as antibiotics, antipsychotics and antiarrhythmia drugs.

The statement recommends at-risk TdP patients receive continuous ECG monitoring and provides guidance for managing drug-induced long Q-T syndrome and immediate treatment for TdP. It also lists the drugs and drug combinations most likely to cause TdP.

AACN member Barbara J. Drew, RN, PhD, FAHA, chair of the statement writing committee, notes the importance of this information to the clinical community. Drew, who teaches cardiovascular and critical care nursing at the University of California, San Francisco, conducts research related to cardiac electrocardiology and cardiac monitoring.

"This scientific statement is particularly important for healthcare professionals who administer Q-T-prolonging drugs in hospital units where patients have continuous ECG monitoring such as in ICUs. If the ECG warning signs of TdP are recognized on the patient's cardiac monitor, then TdP and subsequent cardiac arrest should be avoidable," she says.

SOURCE American Association of Critical-Care Nurses