What would you do first?

  1. With a baby who has respiratory depression due to narcotics before it's birth? Would you give O2 then narcan or vice versa? Everyone seems to have their own opinion so I figured I'd ask here and see what I get.

    I'll tell you what our facility does a little later.
    •  
  2. 22 Comments

  3. by   nurseangel47
    Remembering the ABCs of resuscitation: airway, breathing, circulation...
    I'd go for the oxygenation, then narcan and there should hopefully be more than one pair of hands doing this type of resus...so simultaneous efforts might could afford one doing the airway assist and the other(s) taking care of the narcan aspect...that's my opinion and preference for order of things anyway...and I'm not a NICU or nursery nurse, either...just ol' common sense nursing judgement....
  4. by   ElvishDNP
    Depends on the situation, of course. NEVER NEVER give Narcan to a babe whose mom got opioids less than an hour before delivery (at least not in our hospital) or who has used crack/cocaine.

    I personally try some stim to make him cry if his lungs are junky. Sometimes that alone does the trick. If he's still junky we do chest PT. Then we try bbO2. Very rarely do we Narcan babies, although it does sometimes work miracles.

    Every situation is different though.
  5. by   SmilingBluEyes
    Os first. Narcan only if your ABC interventions are not working. ALL newborns receiving Narcan go to our nursery for a mandatory 4 hours' minimum observation, on the monitors, if they receive Narcan.

    We rarely, if ever, use Narcan anymore. I can't remember the last time we really did!
    Last edit by SmilingBluEyes on Dec 12, '06
  6. by   AnnieOaklyRN
    Arwen what is the contraindication for giving a newborn narcan if mom was given opoids less than an hour before delivery?? I am not familar with this and am just looking for more info. thanks

    Swtooth
  7. by   LizzyL&DRN
    Quote from swtooth
    Arwen what is the contraindication for giving a newborn narcan if mom was given opoids less than an hour before delivery?? I am not familar with this and am just looking for more info. thanks

    Swtooth
    :yeahthat: Why wouldn't you give narcan in this situation? Seems to me if mom got opioids within 1 hour of delivery you'd be more likely to need narcan. I know you don't give it if mom is an addict and used lots of drugs during pregnancy.
  8. by   CH080605
    Quote from eden
    With a baby who has respiratory depression due to narcotics before it's birth? Would you give O2 then narcan or vice versa? Everyone seems to have their own opinion so I figured I'd ask here and see what I get.

    I'll tell you what our facility does a little later.
    Having just finished taking a test on this, I'd say O2!! We're taught Oxygen first, then Fluids and everything else. Always check your ABC's!
  9. by   Humbled_Nurse
    If the baby truly needs Narcan because they aren't breathing then O2 isn't going to be a whole lot of help to the baby since the baby isn't breathing. Once the baby is breathing though a little blowby O2 won't hurt.
  10. by   Jolie
    Resuscitation of a newborn always begins with drying, gentle tactile stimulation, and proper positioning of the infant. In most cases, this will be sufficient to stimulate respiratory effort.

    If a newborn has true respiratory depression, simply giving O2 (via blow-by or mask) will not suffice. If the kid isn't breathing, the concentration of O2 being supplied to him is irrelevant, because it is not getting into his lungs.

    In the case of respiratory depression, PPV is needed, and should always be attempted prior to administering any drug, especially Narcan, because it is possible that the baby's respiratory depression is due to retention of CO2, and not the narcotics. It is never safe to assume that a baby is depressed simply because mom has recently received narcotics. In fact, most infants who are exposed to narcotics shortly prior to delivery have no respiratory depression at all.

    So, to sum it up: 1. Dry, stimulate and position infant. 2. PPV for babies with respiratory depression. 3. Narcan is a distant third, and to be used with great care.
  11. by   eden
    So at my facility we do O2 via PPV first then narcan though there have been some nurses where I work that suggest narcan should be given first. They say that the narcan will reverse the effects of the narcotic and therefore the respiratory depression in the baby without the need for PPV.

    I personally do O2 first and am anxious to see what the revisions to NRP will be and if any of this will be part of the revisions.
  12. by   louloubell1
    Baby needs to breathe while narcan is being drawn up, administered, circulating, and exerting effect. This takes time, and if they aren't breathing on their own or not ventilating sufficiently they need PPV via mask now, not 4 minutes from now. Always, always, always breathe the baby. Matter of fact, the answer to almost every question you'll ever be asked in NRP is: Breathe The Baby. Oh, and I disagree with the notion of no narcan if mom received opioids less than an hr before birth.
    Last edit by louloubell1 on Dec 13, '06
  13. by   nurse79
    Just last week a nurse on our unit used narcan for an infant that was NOT breathng despite tactile stim and O2. she has never used it but the infant began breathing instantly..before even the full dose was injected. I too believe it should be used as a last resort...
  14. by   rjflyn
    I just recertified NRP, Narcan hardly gets a mention. If the baby isn't breathing it needs as others have stated positive pressure ventilation. Also one needs a route to give the narcan, and you best be securing an airway ie ET tube before even thinking about IV access.

    Rj

close