NARCAN - what's your policy

  1. 0
    I have been a nursery nurse for many years, but have only had to give Narcan a very few times. However, I have had to give it twice this week and the question of policy has come up - when exactly to give it, who (officially) orders it when NEO is not present, etc.

    I KNOW NOT TO GIVE IT to babies of addicts and will ask beforehand if I am not sure about mom's Hx, so we can skip that part, but otherwise what is your institution's policy?

    How compromised does the baby have to be? No resp effort despite good HR? Poor/irregular but improving resp. effort even after stim and BB?

    What if the nurse thinks the baby needs it but the OB refuses to order it in the delivery room and no other docs are present to order it?
    (had this happen with a slow to breath baby whose mom had narcotic 45 min before delivery - this OB is not my favorite doc)

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  2. 9 Comments...

  3. 0
    According to the new NRP guidelines:

    -To give Narcan BOTH of the following must be present:
    1. continued respiratory depression after PPV has restored normal heart rate and color and...
    2. a history of maternal narcotic administration within the past 4 hours.

    After administering continue PPV until babe breathes normally, may need repeated doses as naloxone wears off before narcotic.

    As you said, don't give with mother addicted to drugs or on methadone as seizures may occur.

    Dose= 0.1 mg per kg

    As far as who orders it I'm not sure. Its a standing order where I work.
  4. 0
    I am not specialized in OB; however, I try to take a conservative approach if possible. From the OP, I gather that the kiddo was improving with stimulation and blow by oxygen? It does not sound like PPV or chest compressions were required? In this case, I could go along with a wait and see approach.

    My employers policy generally follows NRP guidelines. However, I must state again, delivering kiddos is not a tyical task performed at my place of employment.
  5. 0
    Quote from MalgaBSN
    According to the new NRP guidelines:

    -To give Narcan BOTH of the following must be present:
    1. continued respiratory depression after PPV has restored normal heart rate and color and...
    2. a history of maternal narcotic administration within the past 4 hours.

    After administering continue PPV until babe breathes normally, may need repeated doses as naloxone wears off before narcotic.

    As you said, don't give with mother addicted to drugs or on methadone as seizures may occur.

    Dose= 0.1 mg per kg

    As far as who orders it I'm not sure. Its a standing order where I work.
    :yeahthat:

    We rarely get OB's saying anything about babies because they don't want to deal with them, once they are out. We use narcan and ppv according to protocol and call the peds if needed.
  6. 0
    I've given narcan a few times to babies whose mom's had had narcotic close to delivery time and who are very floppy and not making respiratory effort. As far as I can recall, PPV was always tried first and although the heart rate improved, baby still wasn't trying to breath.

    In my hospital, any OB, family doctor, or member of the resuscitation team can order it. I've never been faced with a doctor not wanting it given. I suppose you could call for peds backup in such a case. I think that's completely reasonable if you need help with a resuscitation.
  7. 0
    When I last took NRP, the new books were just out but we were taught with the older ones. I am due soon for a recert.

    I have since asked around at work and found some answers, although I am still awaiting an answer about the doc who orders. If anesthesia is in the room, nsy apparently has a standing agreement that they will cover the order, but recently they are not attending all deliveries anymore and there is rarely a neo present at delivery. Calling the pedi is out of the question in a rescus. situation.

    We computer chart now and chart our meds in the 'e-MAR'. To enter the drug into the e-MAR, we must designate and 'ordering physician' before entering the order. The babies have a barcode sticker secured to their ankle ID band 'tail' shortly after birth. We are supposed to scan that before charting in the e-MAR and prior to actually giving the med (positive patient ID). Of course, Narcan is charted after the fact and we scan and then back-time the entry for the actual time given, even so, timely entry of all this is a consideration.

    Anyhow, thanks for your replies... I need to work it out with my unit supervisor.
  8. 0
    Our neos/pedis seem to be VERY conservative with Narcan. I see babies all the time that would probably benefit from a dose but nobody will order it, even if mom has no SA hx. I've given it maybe twice since I've been at my current facility (about 2.5 yrs).

    I'm also due for NRP recert soon so maybe will get some answers then!
  9. 0
    I've given narcan a lot. The peds at my old hospital way over used it, esp. since we have bunches of untreated drug addicts, that aren't usually forthcoming with this info. I have given narcan to babies who's moms didn't have narcs during labor! Of course this was when I was a brand new nursery RN, and didn't know any better, when the ped said give it, I assumed he knew that the mom had received a narcotic. Wrong.

    In NSVD it was pretty much my call to give it or not, we just kind of called out to the OB "Hey, I'm gonna give narcan", he/she said "K", and that was that. Wrote it later as a verbal order. In c-sec, it was peds call to give or not, and like I said, they went over board! I'm just waiting to hear about the baby that has a seizure there, r/t undx drug abuse and narcan administration.
    Last edit by crissrn27 on Nov 29, '07
  10. 0
    I just got my NRP recert & there was no mention whatsoever of Narcan. Go figure. I'll look & see what I can find when I go back to work.
  11. 0
    Quote from MalgaBSN
    According to the new NRP guidelines:

    -To give Narcan BOTH of the following must be present:
    1. continued respiratory depression after PPV has restored normal heart rate and color and...
    2. a history of maternal narcotic administration within the past 4 hours.

    After administering continue PPV until babe breathes normally, may need repeated doses as naloxone wears off before narcotic.

    As you said, don't give with mother addicted to drugs or on methadone as seizures may occur.

    Dose= 0.1 mg per kg

    As far as who orders it I'm not sure. Its a standing order where I work.
    Same here., and IF we give narcan, the kid has bought at least 8 to 12 hours in the nursery on mandatory observation per our protocol. I have not seen narcan used in at least 2 or 3 years. You have to watch, for all the reasons already mentioned. Also, you have a tendency to need to repeat it; it wears off fast. We watched resper/cardiac status in these kids in our SCN for these very reasons.

    deb
    Last edit by SmilingBluEyes on Nov 29, '07


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