Endotracheal Med Administration...Help!
- 0Nov 7, '09 by stellina615So, it's Saturday night and my date for the evening is my ACLS book. I'm going for initial certification, and I'm a new nurse with relatively little experience in the types of situations that ACLS covers (I'm starting on a med surg floor and fortunately, we don't have intubated patients). As I'm going through the material, I'm reading about how narcan, atropine, vasopressin, epi, and lidocaine can be given through the ETT if IV/IO access can't be established. What I'm trying to understand is, wouldn't putting medications into a patient's trachea put them at risk for aspiration or pneumonia? I realize that someone with an ETT and no IV/IO access probably has bigger fish to fry, but I just don't really understand how ETT med administration is done and whether or not it sets patients up for respiratory problems as they recover. Thank you to anyone who can help clear this up for me!
- 21,247 Visits
- 3Nov 7, '09 by TDFlMedicRNHere ya go.
"endotracheal (ET) tube. Instilling some resuscitation drugs via an ET tube results in lower circulating blood levels of the medication and lower survival rates compared with I.V. administration. Use this method only if I.V. or IO access can't be established. Only naloxone, atropine, vasopressin, epinephrine, and lidocaine can be administered via ET tube. The recommended dosing is two to two and a half times the I.V. dose, although little evidence supports this practice. After diluting the recommended drug dose in 5 to 10 mL of sterile water or 0.9% sodium chloride solution, instill the drug directly into the ET tube, followed by ventilations via a bag-valve—mask device."
Ultimately, survival of the patient depends far less on what drugs we give and when than on how well we maintain central perfusion. Patients who have taken an anoxic hit from a code, been aggressively resucitated, and are post-code in your unit will have fluid balance issues, neurological issues, respiratory issues, and post-resucitation arrythmias. 50-60 cc's of total fluid volume into their lungs isn't going to push the balance one way or the other.
Ultimately, if you're looking at spraying drugs down someone's ET tube, you're reaching the "something is better than nothing" stage - do we need to say much more?
IOW - a little aspiration pneumonia is the LEAST of their worries - and yours.
American Heart Guidelines from "Circulation" circa 2005. Medications in an arrest situation are not all that important. Endotracheal medication administration have been highly de-emphasized due to the fact that IV medications do not seem to make much if any difference, and ETT medications appear to do the same, while potentially leading to additional complications in some cases.
I would not worry too much about the details of giving meds down the tube.
- 0Nov 8, '09 by Da_Milk_of_AmnesiaThe last time I put meds down a tube was in a code back in 2005, I really havent seen it done in quite a while. Personally It'd be the last route I'd be giving meds...But then again as someone above me said..something is better than nothing, and when you're in the crap, ya gotta go what ay gotta do.
- 0Quote from blondy2061hLots of things happen during surgery. The primary induction agent and paralytic prior to inhaled anesthesia is given IV, medications to control hemodynamics are given IV, volume expanders and blood products are given IV, and multiple other therapeutic agents and diagnostic agents are given IV during surgery as well. Therefore, IV access is mandatory for multiple reasons related and unrelated to the administration of inhaled general anesthetic gasses.I've always kinda wondered about this too. I figured in the code situation it may be indicated if there's not any alternative. However, ET route is often used for anesthesia as well. A person undergoing anesthesia always has IV access. What's up with that?
- 0Nov 8, '09 by blondy2061hQuote from GilaRNI get that. My question was if ET med administration is such a bad thing that should be avoided whenever possible, why are anesthetic agents given this route?Lots of things happen during surgery. The primary induction agent and paralytic prior to inhaled anesthesia is given IV, medications to control hemodynamics are given IV, volume expanders and blood products are given IV, and multiple other therapeutic agents and diagnostic agents are given IV during surgery as well. Therefore, IV access is mandatory for multiple reasons related and unrelated to the administration of inhaled general anesthetic gasses.