Narcan at Delivery

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Specializes in Perinatal, Education.

The recent post about delaying Narcan 2 hours post delivery got me thinking about my own hospital. We have recently trasitioned from having nursery do the newborns about 2 hours post delivery to having either the L&D nurse or a nursery admit nurse do the newborn care in the LDR room during the first 2 hours while the parents can watch. I like the new system. I am comfotable with doing newborn care, but I am not as familiar with our nursery protocols and ped orders as I would like to be.

Our OBs give either Stadol or Nubain for pain intrapartum. If either is given too close to delivery the baby sometimes has some minor respiratory sx soon after delivery--but not always right at delivery. A dose of Narcan seems to help a lot. Sometimes we will give the Narcan right after delivery if we are worried because of pain meds within 30 minutes to an hour of delivery. I believe we are kind of doing this under NRP guidelines and not specific orders from the ped because it is 2am and not really a good time to call. Do you get what I'm saying?? However, we aren't really responding to resp distress but preventing it.

Do any of you have protocols at your facilities for this kind of thing? Anyone else see apnea about 1-3 hours postpartum after Stadol? High pitched crying after Nubain? I would love to hear how this is addressed as I feel our unit needs to revamp their thinking on this.

Thanks

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Can honestly say I've never heard of Narcan being used. I worked in a regional maternity centre that had a high risk population. Maybe, its a US thing?

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Specializes in OB.

I thought that Narcan didn't reverse the affects of Nubain. We as L&D nurses can't give Narcan, we have to hit the "code pink" light, then NICU comes running and a NNP has to give an order for Narcan. Have only seen Narcan used once, it was due to the fact that the pt recieved Fentanyl 45 minutes before an emergency c-section. Baby had NO respiratory effort, NICU was there and the baby was fine.

Molly

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Specializes in Perinatal, Education.

We have no NICU and are basically the nurse in charge of caring for the baby for the first hour or two after birth. There really isn't anyone to call except for respiratory. We're on our own. Small community hospital--no residents or MDs in the middle of the night. I looked up Nubain in my drug book and the antidote is Narcan.

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Specializes in Perinatal, Education.

Aren't you NRP certified? I know Narcan is part of the code process--can you not run a code without the NICU? I would think you wouldn't want to waste the time.

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I haven't used it unless it is obvious that the baby is depressed. I keep it in the room just in case....That is neonatal protocol..I have also had to use it in a mom who was overwhelmed and very sleepy with a pca..She woke RIGHT up let me tell you..Moms using antidepressants can have very listless, although pink and breathing babies. I pretty much expect that from a mom on those meds..Sometimes with that it isn't easy to figure out if narcan is needed when the sleepy baby comes out. Rarely do we have to give it but when in doubt, I say do it.....

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In our unit, narcan is a nursing decision but if we are in delivery then we are trusted to make the correct choice..Usually you have to time to consult either pedi or the OB, but if I get a really sleepy baby with hardly any tone and the only risk factor is a lot of drugs on board and then a delivery, I give the narcan and get the order afterwards....

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Mermaid said it well. Also with Narcan, you must be careful and KNOW mom's history. Because if she used certain illicit or street drugs , narcan can make things worse or in a worst case scenario, KILL the newborn! Definately know your NRP and know the mother's history, as best you can. I have been known to ask moms if they use drugs (history of + drug screens), have them deny, only to rescind and admit when I tell them that the medicine I give their baby can actually make things worse if I don' t know not to give it-------that narcan can kill in some cases. They usually then open up and tell me the truth. It's not a judgement I am after, but knowing what to expect and what to do when the baby is born! (and having a ped/NNP at the warmer when the baby does come).

PS we have no NICU in our hospital, the nearest one is 25 miles up the road. So there is no excuse for not using NRP per protocol every time. WE don't have that safety net, after all.

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Oops! Thats right! Forgot to mention the thing about narcotic addicted moms....If I even have a hint of suspicion that I might need it, I keep the stuff in my pocket! (not the narcotics, the narcan!) Can you tell I just finished a double ???Wild and crazy in delivery last night!

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We always have Narcan available and can use it if necessary, but it is highly unusual to need it at all.

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It's good practice to have the narcan either in your pocket, or taped in a cool spot on the warmer. It is not a drug that is given to prevent an infant from becoming resp. depressed. Narcan is given to a depressed infant, and that infant must be watched like a hawk. The effects of the narcotic can return within a 15-20 min time frame, and resp. depression will reoccur. Another dose of narcan will be needed, and this baby must be sent to the nursery for close observation. If a drug addicted mother delivers, narcan is not to be given, peds must be present at the delivery.

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Specializes in Perinatal, Education.

Thanks for all of your replies. It has given me good food for thought. It is very rare that we use Narcan as well. I'm still wondering if anyone else has had trouble with post Nubain and Stadol babies having delayed effects. They come out pink and stable and great and then crumple a couple of hours later.

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