Valsva Manoeuvre

Question 1

Indications valsalva manoeuvre

Answer 1

AVRT

AVNRT

Question 2

Contraindications for valsalva manoeuvre

Answer 2

Systolic BP <90

Unstable or rapidly deteriorating pt

Atrial fibrillation or atrial flutter

Question 3

Clinical precautions valsalva manoeuvre

Answer 3

None

Question 4

Equipment required valsalva manoeuvre

Answer 4

10ml syringe

Cardiac monitor

Question 5

Prepare patient valsalva manoeuvre

Answer 5

Reassure and explain

Ensure complete baseline VSS

Attach cardiac monitor and suitably position for good view

IV access not essential

Open new slip tip 10ml syringe and ensure barrel is freely moving

Hand syringe to pt with barrel pushed in

Question 6

Select manoeuvre valsalva manoeuvre

Answer 6

Modified valsalva (preferred) ((trial showed it’s more effective))

Or standard valsalva (where manual handling concerns prevent use of modified valsalva)

Question 7

Modified valsalva manoeuvre

Answer 7

Position pt semi recumbent

Press snapshot button to record cardiac rhythm

Encourage pt to forcibly exhale into syringe for approx 15 seconds with enough pressure to push plunger out, followed by normal breathing

Immediately lay patient flat and raise legs to approx 45degrees for 15 seconds

Lower legs and return pt to semi recumbent position

Question 8

Standard valsalva manoeuvre

Answer 8

Position pt supine

Press snapshot button to record cardiac rhythm

Have pt take one normal breath and hold it

Encourage pt to exhale forcefully into syringe for approx 15 seconds with enough pressure to push plunger out, followed by normal breathing

Question 9

Reassess patient valsalva manoeuvre

Answer 9

Confirm cardiac rhythm

reassess VSS

Question 10

How many times and how frequently can you do valsalva manoeuvre?

Answer 10

Repeat at 2/60 intervals

Max 3 attempts

Question 11

When to request mica for failed valsalva manoeuvre

Answer 11

If BP <90 or no reversion after 3x attempts at valsalva