sucrose for sedation

SteveNNP, MSN, NP · Jan 2, 2010

Oral sucrose is intended for minor procedural pain, like IV sticks, circs (in addition to lido block) etc...I do occasionally use it for crabby NPO (except NEC) or withdrawing kids. The sucrose is absorbed in the buccal mucosa, and shouldn't prove risky for causing NEC.

If your unit is in the habit of using oral sucrose for patients with chest tubes, I would suggest implementing a change to narcotics such as fentanyl for pain mgmt. Sucrose is highly inappropriate for pain control in that situation.

KatRNC · Jan 2, 2010

Oral sucrose is intended for minor procedural pain, like IV sticks, circs (in addition to lido block) etc...I do occasionally use it for crabby NPO (except NEC) or withdrawing kids. The sucrose is absorbed in the buccal mucosa, and shouldn't prove risky for causing NEC.
If your unit is in the habit of using oral sucrose for patients with chest tubes, I would suggest implementing a change to narcotics such as fentanyl for pain mgmt. Sucrose is highly inappropriate for pain control in that situation.

Steven,

Thanks for the reply, we can't seem to get the docs to give narcotics unless the infant is intubated. I will keep trying, of course! I started NICU nursing when "infants didn't feel pain" was the thought of the day, so I guess there IS some slight improvement...

As for what you said regarding sucrose with NEC? Patients who are no longer sick with NEC, but just hungry, if the sucrose is absorbed in the buccal mucosa, which is what I've always understood, and shouldn't cause NEC, why would it be inappropriate in that type of infant as well?

Kathy

Elvish, BSN, DNP, RN, NP · Jan 2, 2010

I do occasionally use it for crabby NPO (except NEC) or withdrawing kids.

THANK YOU! I have caught all kinds of heck for suggesting that we use it for a withdrawing baby on occasion, when they are absolutely incorrigible. Our policy says it's to be used prn for 'discomfort'. I can't think of a more appropriate use than in a withdrawer.

SteveNNP, MSN, NP · Jan 2, 2010

As for what you said regarding sucrose with NEC? Patients who are no longer sick with NEC, but just hungry, if the sucrose is absorbed in the buccal mucosa, which is what I've always understood, and shouldn't cause NEC, why would it be inappropriate in that type of infant as well?
Kathy

It would only be inappropriate in a patient who is still NPO secondary to NEC. I wouldn't put ANYTHING in that baby's GI tract until given the OK...

Another patient I wouldn't give sucrose to is a few types of TE fistulas. Unless that esophagus ends in a blind pouch... nothing goes in that kid's mouth.

Mimi2RN, ASN, RN · Jan 2, 2010

We also give it to hypoglycemic infants that can't be given formula. It'll bring the sugar up so you don't have to stress about getting the IV in. Not all babies are co-operative when it comes to IV's, and our docs don't always want to do lines.

littleneoRN · Jan 3, 2010

Why can't these infants be given formula? Sweet-ease is not designed for consumption more than small drops (I think our policy says 0.05-0.5 ml up to eight times per day). This amount will not bring up and maintain glucose within normal limits. There is such thing as D5 oral water for hypoglycemic babies and of course formula. I'm not a big formula advocate, but I think it's a better option than Sweet-ease. And I also think that if hypoglycemia is profound enough to warrant lines that Sweet-ease will not do the trick.

NICU_babyRN, BSN, RN · Jan 5, 2010

We use sucrose for minor procedures such as IV placement, blood draws (heel) and other reasons listed above but never as the only means of sedation.

BittyBabyGrower, MSN, RN · Jan 7, 2010

Using sucrose for hypoglycemia is inappropriate....try defending that one in a court of law without a procedure/policy to back you up! We have a hypoglycemic algorithm to follow. How much are you giving them?

We are going to start using EBM if mom is pumping instead of glucose :)

As for the chest tube comment....ask those docs if it would be appropriate to have an adult with a CT and offer them a Hersery bar for pain management...same freaking difference! Those kids need morphine!

We also do not use it on withdrawl kids...it alters the score and if they are that darn fussy then they warrant that higher score to get the meds adjusted!