When to give Narcan??

[climbeRN]

I'm new to adult nursing so I haven't dealt with overdoses and don't know what they look like. Recently, I had a pt with an orthopedic surgery who had dilaudid ordered. I gave one dose and pt was fine; after second dose (4 hrs later), pt's RR dropped to 5/min. In my hospital we have critical care nurses that we can call to evaluate the pt/situation. The critical care RN came and I asked about giving Narcan. She said not to give it because it might reverse all of the symptoms (extremely high BP, high HR) that the pt was experiencing before. The patient was only arousable to voice after calling their name about 10 times (I would say, arousable to pain because I did a sternal rub and they barely woke up). I didn't give the Narcan and in the end the doctor yelled at me for not giving it when he saw the vital signs in the morning, but both my charge RN and the critical care RN said not to give it.

Also, I put the pt on continuous pulse ox after the critical care nurse left and they were 97% on 1 L O2. But does that mean the pt is ok with a RR of 5? Or can CO2 still build up and cause problems?

So my question is what are the criteria for giving Narcan? What respiratory rate? What level of consciousness? If they still open their eyes (even if for only a few seconds) does that count as alert enough to not give it? thanks!

[Triddin]

I don't think there is a set guideline for when to give narcan. In this situation, I personally would have given it- the high bp and hr could have been related to the fact the patient was in pain, and then given smaller doses of pain medications to control the pain.

I can see the outreach/ charge nurses's perspective. If the rate was 7-8, I would have held off on the narcan too. 5 is a just bit low for my comfort.

[Buckeye.nurse]

This is a hard situation when you have a critical care nurse and your charge nurse telling you to do something. Did you also page the doctor? That's usually a good action to take, even if you have more experienced nurses at the bedside. It keeps them in the loop, and covers your butt. They can adjust the doses of medications if needed, come examine the patient if they feel it is warranted, and might order a small dose of Narcan (0.1 or 0.2 mg).

As for the question at the end of your post, we occasionally get overflow Sickle Cell patients on my floor if the Benign Heme unit is full. We give Narcan for low RR (

[iluvivt, BSN, RN]

I would have given it.This patient was somnolent very difficult to arouse and had s RR of 5. Generally speaking of the RR drops below 7,pt is difficult to arouse,the respiration are shallow and of poor quality you need to give it. Sure it will do its job and reverse the effect of the narcotic and the pt may be in pain again but after they recover a dose more appropriate can be administered.You also need to study the pt profiles that may have a propensity to overdose such as older age,obstructive sleep apnea and smokers to name just a few.

[climbeRN]

I didn't page the MD, but in retrospect, I know I should have. I was just so unfamiliar with the situation and trusted my charge and critical care nurse (especially since I'm new to med surg, I tend to think, oh I'm probably just over-reacting), and they didn't seem worried at all. But in the future, I'll definitely try to be more proactive about calling the MD if I just have a bad feeling about something, which I did.

Thanks for the clarification on guidelines for RR and level of consciousness to give narcan! this helps a lot!

[iluvivt, BSN, RN]

Here is how I look at.....if the patient does not need it and gets it will harm come to the patient....NO....but if the patient needs it and does not get it...most certainly harm may come to them.

[Munch]

This is a hard situation when you have a critical care nurse and your charge nurse telling you to do something. Did you also page the doctor? That's usually a good action to take, even if you have more experienced nurses at the bedside. It keeps them in the loop, and covers your butt. They can adjust the doses of medications if needed, come examine the patient if they feel it is warranted, and might order a small dose of Narcan (0.1 or 0.2 mg).

As for the question at the end of your post, we occasionally get overflow Sickle Cell patients on my floor if the Benign Heme unit is full. We give Narcan for low RR (

Yeah giving narcan to a SCC patient(unless of course they are coding or about to code) could definitely cause a world of hurt considering the doses of narcotics I've seen some of them on. They will have to deal with the painful withdrawal in addition to crisis pain..not pretty at all.

[Farawyn]

Here is how I look at.....if the patient does not need it and gets it will harm come to the patient....NO....but if the patient needs it and does not get it...most certainly harm may come to them.

This. When in doubt, give it.

[MunoRN, RN]

The standard goal for titrating Narcan doses is a RR of 8 or greater, you actually don't want to over do it and you can definitely cause harm by giving narcan, it shouldn't be considered a 'when in doubt just give it' sort of drug. One of the biggest risks has to do with the half-life of narcan compared to the half-life of the opiates you are reversing. Narcan can result in severe pain and overstimulation of the sympathetic nervous system, which then requires additional opiates to counteract, often requiring an even larger dose of opiates than what caused the initial over-sedation. The problem is that the narcan will wear off long before the opiates do, and then your left with a patient with a respiratory rate of zero instead of five.