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)
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
Nov 29, '07
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.
Last edit by SmilingBluEyes on Nov 29, '07