UMEM Educational Pearls

Title: Single-Syringe Adenosine for SVT: A Simplified Approach

Category: Pharmacology & Therapeutics

Keywords: Adenosine, Supraventricular Tachycardia (SVT), Single-Syringe Technique (SST), Double-Syringe Technique (DST) (PubMed Search)

Posted: 10/9/2026 by Wesley Oliver (Updated: 10/23/2026)
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Serving as an update to a prior UMEM Pearl (https://stg.umem.org/educational_pearls/3697/), recent evidence strongly supports transitioning from the traditional double-syringe technique (DST) to the single-syringe technique (SST) for stable supraventricular tachycardia (SVT) termination.

The standard DST involves an intravenous adenosine bolus via a stopcock followed immediately by a 10 to 20 mL normal saline flush. This method often requires two nursing staff and extra equipment, which can be difficult in resource-limited settings or lead to administration delays. By diluting adenosine directly with normal saline to a total volume of 15 to 20 mL in one syringe, the SST offers a highly effective and simplified alternative.

Recent evidence, including a 2022 pilot randomized controlled trial by Kotruchin et al. and a 2023 systematic review and meta-analysis by Miyawaki et al., demonstrates the clinical value of the SST:

High Efficacy: A randomized controlled pilot trial demonstrated a 100% termination rate with the SST compared to 93.3% for the DST.
Safety Profile: Both administration techniques were well tolerated, with no adverse events observed in the pilot trial.
First-Dose Superiority: A review of 180 patients across four studies found that while overall termination rates and total administered doses were similar, the termination rate at the first dose was significantly higher for patients receiving the SST (Odds Ratio 2.87; 95% CI 1.11-7.41; p=0.03).
Simplified Administration: The meta-analysis highlights that the SST represents a more rapid approach that reduces the margin of error by obviating the need for syringe switching or a three-way stopcock.

Mixing the standard 6 mg or 12 mg adenosine dose into a 20 mL syringe with normal saline allows for a rapid, 1-2 second single-provider push through a large peripheral vein.

References

Kotruchin P, Chaiyakhan IO, Kamonsri P, et al. Comparison between the double-syringe and the single-syringe techniques of adenosine administration for terminating supraventricular tachycardia: A pilot, randomized controlled trial. Clin Cardiol. 2022;45(7):583-589. doi:10.1002/clc.23820

Miyawaki IA, Gomes CP, Moreira VCS, et al. The single-syringe versus the double-syringe techniques of adenosine administration for supraventricular tachycardia: a systematic review and meta-analysis. European Heart Journal. Volume 44, Supplement 1, Abstract ehac779.025.