• 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
Patient Factors & Considerations
  • 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.
Additional Information


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