Narcan drips

[JMBucka]

Hi,

I work in a PICU in St. Paul, MN. We are small unit with only ten beds, speciailizes in orthopedics, trauma, neurological disorders, neurosurgery, and other medical issues. Recently, a few of our anesthiologists have been ordering for patients to be on narcan drips for pruritis. These patients go to the floor post-operatively and then end up having to come to the ICU because of the narcan drip. We do not have a policy that supports narcan drips on the floor.

What are other PEDS hospitals policies regarding narcan drips?

Thanks!

[NotReady4PrimeTime, RN]

Wow. I've worked PICU for nearly 17 years and have only ever seen one patient on a Narcan infusion. And that was a toddler who'd ingested a bunch of Grandma's MS Contin.

The use of Narcan as either prophylaxis or treatment of opioid-induced pruritus hasn't been studied enough for good data on its efficacy or apporpirate dosing. It hasn't ever been on our radar here. The few studies that have been carried out have identified limitations in its use, due to difficulty in finding the balance between adequate analgesia and acceptable itching. I think in your situation there needs to be a concerted education effort for the staff on your inpatient units so they understand the rationale for the infusion, which isn't to reverse a potentially life-threatening respiratory depression from opioid use, but to reduce the itching. There also needs to be a protocol with standard orders developed for the ward staff so they aren't overly stressed by having a patient on the infusion similar to the one your hospital must have for continuous morphine infusions on the wards.