At a Recent course I attended (S.T.A.B.L.E. Instructor) the instructor stated that VERSED is no longer recommended for use in Neonates, (something to do with Increased risk of IVH).
My Unit uses it very often, in fact it is the drug of choice (combined with Fentanyl) for most intubated neonates. We do sometimes use Ativan in place of Versed.
I am wondering what your units policy is, and if you can point me to any specific references/consensus statements that support this claim.
Specializes in ER, NICU, NSY and some other stuff.
My husband gave me a summary from the Cochran library that looked at 2 small studies regarding versed. In one of the studies they cited a higher incidence of IVH, longer stays and even death.
Was news to me too since we used it in one of the units I used to work in.
Okay, I'm at work now and coming up with no new information. Could someone direct me to these studies so I can get copies, please? Thanks! I'll do a search when I'm off of work, but if you happen to know a direct link or resource, let me know. ;>)
Ng E, Taddio A, Ohisson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit (Cochrane Review). In: the Cochrane Library, Issue 4 2002.
The STABLE (Sugar, Temperature, Assisted Breathing, Labs, Emotionial support) program works hand in hand with programs such as NRP, but focuses on stablilization post post-resuscitation/pre-transport... Here is an excerpt from their website
The S.T.A.B.L.E. Program is the first neonatal outreach education program to focus exclusively on the post-resuscitation/pre-transport stabilization care of sick newborns. This valuable, accessible and easy-to-remember mnemonic-based resource serves as a concise guideline to organize the myriad of details and interventions necessary for stabilizing a sick infant. First introduced in the U.S. and Canada in May 1996, this program and has rapidly grown in popularity with over 20,000 Learner participants to date!
/quote
A good program VERY in depth, covers X-ray interp, lab interp... and things along those lines..
Just an FYI kind of thing...the sedation options for my grandson is phenobarb, MS & Fentenyl...I asked his nurse...OHSU stopped using Versed on preemies about a year ago...no explaination was given.
our level iii nicu in southwest georgia was a perinatal center responsible for transporting patients into us from 13 surrounding counties.
we had a nurse who was our outreach coordinator whose job it was to help keep relations smooth and operating efficiently between our hospital and all the smaller outlying hospitals.
the outreach coordinator worked hand in hand with our transport team coordinator who was also an rn.
the two of them would go together to the outlying hospitals and teach the s.t.a.b.l.e. course to the employees at these small hospitals. (they were also nrp instructors and would re-certify physicians and other nrp providers at the small hospitals.)
of the hospitals that delivered babies, only one of them had a special care nursery and none had a nicu. they only cared for well babies or feeders-n-growers. when a baby became sick or was born with problems, they often were at a loss as to how to care for and stabilize them during the time it took for them to contact us and us to get to their hospital to transport the baby to us. some of our hospitals only delivered babies in emergency situations, so you can imagine how poor their baby skills were.
unfortunately they could not recognize hypoglycemia, or if they did, they'd give the wrong amount of d10. babies would often be freezing causing more problems. they might have a ventillator but they never used it more than once a year or so; this sometimes caused more problems as you could imagine... can you say "pneumo"? labs and other pertinent prenatal information would not be available, etc.
when this s.t.a.b.l.e. program came to us and we were able to implement it, we saw an incredible increase in the proper stabilization of the babies when we'd get there to pick them up! prenatal records would be complete and in a folder along with l&d records, labs done, x-rays done, etc. we were able to load up the baby quickly, take it to mom for a quick peek and to introduce ourselves and give her some literature, phone numbers, etc. and be on our way with the baby. the employees at these hospitals felt wonderful that they now had the resources they needed to do their job well. they were empowered and it showed in many ways, most importantly in the health of the babies and the emotional support given to the mom and family that had to come to our hospital later after mom's recovery.
this is an example of how i've personally seen s.t.a.b.l.e. work in practice and i very, very highly recommend it.
we also made sure our mother-baby unit nurses were instructed in the s.t.a.b.l.e. course too. any nursing or emt employee was welcome to attend too.
it's a wonderful program and has found it's niche in many applications.
babynurselsa, RN
1,129 Posts
My husband gave me a summary from the Cochran library that looked at 2 small studies regarding versed. In one of the studies they cited a higher incidence of IVH, longer stays and even death.
Was news to me too since we used it in one of the units I used to work in.