PRN sedation + interactions with lipids

[SteveNNP, MSN, NP]

Hello!

I was wondering what you all do as far as keeping your intensive vent babies sedated on your shift. I work nights at a LIII NICU, and find that a lot of times I am "catching" up on my baby's sedation from day shift. Is it just me, or do other nurses feel that if you have a tube down your throat, an immature nervous system, and several painful procedures a shift, you should be PROACTIVELY medicated? If my baby has morphine/versed ordered q2h, I will premedicate[with both, b/c Versed is NOT for pain!] before each assessment/procedure which amounts to q2-4h. I have found that this = a steady as a rock baby who doesn't desat or react dramatically to touch/procedures. Am I right? I still assess for pain q1h! Often I'll get report on a baby who was desatting all day into the 40's whenever touched, only to find he got sedated once or twice all shift. I am a new grad, so I don't have any experience in infant pain management, except what I have learned so far. I also feel this decreases the risk of IVH, since the BP doesn't fluctuate as drastically when they are handled. I also had a pt whose nurse was running Versed into a PCL/PICC along with TPN/lipids. According to Neofax, they are incompatible, Versed being lipid soluble = baby ain't getting any......

Any thoughts/suggestions?????

Thanks for your input!

SteveRN

[Gompers, BSN, RN]

By unit policy, our vented babies are either on continuous morphine/fentanyl drips or get morphine Q4H ATC (scheduled, not PRN). We do pain scores Q1H on all babies, and the narcotic dose is adjusted according to their scores. Anything over a 4 merits increased analgesia.

We rarely use Versed on our unit, and I wish we would for sedation. I only see it on our very post-term chronic babies if they have surgery or get sick and need to be vented (they still get morphine or fentanyl as well). This is rare though - usually if it's a term or post-term baby and we need additional sedation we use Ativan. We used to use Ativan on all the babies, but I guess there are connections between that and neurological problems in preemies so we no longer use it before 38 weeks corrected age.

[dawngloves, BSN, RN]

I think a lot of nurses undermedicate becuase of recent teachings about, "chemical restraints". I have had nurses worry they are snowing a baby that is on a vent and would otherwise cry, thrash and try to extubate himself. What you are doing when you pass on PRN MSo4 is denying that baby the analgesia and rest he needs/deserves.

As far as Versed, we don't have standing orders for it often, but if we need it for procedures we use a seperate hep lock for it and certain meds, blood, ect and we guard it with our life!