- To terminate SVT/narrow complex tachycardia by increasing intrathoracic pressure to stimulate vagal nerve response.
- Recent or current acute myocardial infarction
- Severe coronary artery disease
- Haemodynamic instability (i.e. systolic BP below 90mmHg)
- Known glaucoma or retinal myopathy
- The following side effects might be experienced by the patient when performing the Valsalva Manoeuvre:
- Dizziness
- Hypotension
- Syncope
- Tinnitus
- Headache
- If patient is on the stretcher, procedure is only to be performed while stretcher is locked into ambulance or lowered to ground height.
- All relevant infection control methods are to be utilised.
- Prepare equipment required:
- 10mL syringe
- Oxygen tubing
- Sphygmomanometer
- Explain the procedure to the patient.
- Position patient in a semi-recumbent position.
- Ensure ECG monitor is attached and all vitals are checked/monitored. Resuscitation equipment must be at hand as other arrhythmias may occur.
- Consider IV access prior to performing procedure.
- Patient position – Semi-recumbent
- Connect the sphygmomanometer to the oxygen tubing.
- Instruct the patient to take a deep breath in while placing the oxygen tubing in their mouth.
- Instruct the patient to blow into the tubing and attempt to reach 40mmHg, maintaining pressure for 15-20 seconds.
- Post procedure, patient’s head to be lowered into a supine position with the legs raised (where possible) approx. 45 degrees (Trendelenburg position) for 15 secs.
- If unsuccessful in the first instance the procedure can be repeated once.
- If a sphygmomanometer is unavailable another method is to instruct the patient to try and blow the plunger of a 10mL syringe until movement is just seen for 15-20 seconds.
- Termination of narrow complex tachycardia.
- No more than 2x attempts.
Further Reading:
Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): A randomised controlled trial. Lancet 2015;386(10005):1747–53.
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