NArcan drip

  1. Can anyone tell me why we would have a narcan drip ordered? We use narcan to reverse opioid o.d or oversedation, but are there alternate indications? Also, why a "drip" versus boluses. I am aware that there is a short half life. Thanks
    •  
  2. 10 Comments

  3. by   altomga
    We have used Narcan gtt's for those pt's that took such an overdose that to keep the pt awake, etc. we use the narcan. We would try the IVP, but it wouldn't last long enough. It's not used often, but in special circumstances.
  4. by   rdhdnrs
    I have run a narcan drip to counteract extreme itching from a continuous epidural. That's the only reason I've seen it used.
  5. by   sharann
    Thanks you 2. If anyone has any precautions or adverse effects to watch out for, I'm all ears. I work PACU and we have never heard of using a narcan drip, but apparently it was used many yrs ago and may start coming back for some reason. I think the itching was the indication I heard in this case.
  6. by   2ndCareerRN
    I am aware that there is a short half life.
    That is one of the main reasons. The opiod (usally a drug overdose) has a longer half life. You can keep them in the ER and continually push narcan, or start a drip and put them in ICU. We will often opt for the drip and admission so as not to tie up a nurse and bed in the ER for an extended period of time. It also gives a chance to run a couple banana bags and other fluids to plump up a pt.

    bob
  7. by   bndvillars
    Quote from 2ndCareerRN
    That is one of the main reasons. The opiod (usally a drug overdose) has a longer half life. You can keep them in the ER and continually push narcan, or start a drip and put them in ICU. We will often opt for the drip and admission so as not to tie up a nurse and bed in the ER for an extended period of time. It also gives a chance to run a couple banana bags and other fluids to plump up a pt.

    bob
    Do you know what the recommendations are for nursing care for pt on Narcan drip?
    Recommended dilution?
  8. by   sirI
    Quote from bndvillars
    Do you know what the recommendations are for nursing care for pt on Narcan drip?
    Recommended dilution?
    Hello, bndvillars

    The recommended dose:


    2 mg in 500 D5W, 4 mcg/ml. Infuse at 100 ml/hr to deliver 0.4 mg/hr.

    Be aware of hypo or hypertension, ventricular arrhythmias, nausea and vomiting, effects of drug withdrawal.
  9. by   RNIN46
    I also work in the recovery room, I have never used a narcan drip, but have administer narcan in very small diluted doses...I am currently working on a small task force with a pharmMD, anesthesologist and another RN to try to research any quidelines for reversal agents usage, but most importantly...HOW LONG TO YOU HAVE TO OBSERVE THE PT IN PACU SETTING IF YOU USE A REVERSAL AGENT...IN OR THEY USE, EPIDURALS,INTRATHECALS, IV MORPHINE/FENTANYL, SUFENTANYL, DILAUDID,ALFENTANYL, DEMEROL. Not to mention other agents that we use reversals for. If anyone has any guidelines or information please let me know so I can bring it to our meetings. Thanks
  10. by   patwil73
    Quote from RNIN46
    I also work in the recovery room, I have never used a narcan drip, but have administer narcan in very small diluted doses...I am currently working on a small task force with a pharmMD, anesthesologist and another RN to try to research any quidelines for reversal agents usage, but most importantly...HOW LONG TO YOU HAVE TO OBSERVE THE PT IN PACU SETTING IF YOU USE A REVERSAL AGENT...IN OR THEY USE, EPIDURALS,INTRATHECALS, IV MORPHINE/FENTANYL, SUFENTANYL, DILAUDID,ALFENTANYL, DEMEROL. Not to mention other agents that we use reversals for. If anyone has any guidelines or information please let me know so I can bring it to our meetings. Thanks
    When we use a reversal agent we have to monitor for 90 minutes. It is due (as said above) because of the very short half-life of narcan and longer half-life of the opiod. If we were concerned enough to give the reversal agent we don't want it to wear off and the person go right back into a sedated state - hence the 90 minutes which will usually get you past the half life of any IV opiod you use.

    Hope this helps,

    Pat
  11. by   ZippyGBR
    also if people have taken big ODs of Modified release Morphine or something like a big OD of methadone - - so very long half lives compared to narcan - practice in the Uk has tended to be infusions rather than 'drips' but that's a factor of volume and equipment ( e.g. use a 50 ml syringe pump )
  12. by   ADRadecki
    Aside from the normal use (Opoid reversal) for Narcan gtts, I have seen them used in our ICU as to protect/reverse spinal cord compression/ischemia after descending aortic dissections...in addition to having a lumbar drain in place.
    Last edit by ADRadecki on Jun 12, '10 : Reason: .

close