Maurine Clark, RN, MN, CRNI

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Maurine Clark, RN, MN, CRNI - Description April 21, 2012. Society of Pediatric . Nurses . 22. nd. Annual Convention. Houston, Texas. The Ouchless Hospital. Developing a Nurse Administered Nitrous Oxide Program. ID: 492939 Download Presentation

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Maurine Clark, RN, MN, CRNI

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Maurine Clark, RN, MN, CRNImaurineclark@msn.comwww.ouchlesshealthcare.orgApril 21, 2012Society of Pediatric Nurses 22nd Annual ConventionHouston, Texas

The Ouchless HospitalDeveloping a Nurse Administered Nitrous Oxide ProgramUsing research, current guidelines and the voices of children


Properties of N2O/O2

AnxiolyticAnalgesicAmnesticMinimal sedationPatient remains awake and able to respondRapid onset, rapid recoveryNot metabolizedDelivered with oxygen (reversal agent)Fail safe equipment Phenomenal safety record


Determining nursing scope of practice

Documents provided by the WA State Nursing Commission



Clinical Trials


et al. (2007). Case-series of nurse-administered nitrous oxide for urinary catheterization in children.

Anesthesia & Analgesia, 109

(4), 876-879.

Frampton et al. (2003). Nurse administered relative analgesia using high concentration nitrous oxide to facilitate minor procedures in an emergency department.

Emergency Medicine Journal, 20(5), 410-413.

Babl et al, (2007). High-concentration nitrous oxide for procedural sedation in children: Adverse events and depth of sedation. Pediatrics, 121(3), e528-32.

Babl et al. (2008). Limited analgesic efficacy of nitrous oxide for painful procedures in children. Emerg Med J, 25, 717-721.

Minnesota, USA

Sydney, Australia

Melbourne, Australia

Melbourne, Australia



et al. (2004). The efficacy of premixed nitrous oxide and oxygen for



in pediatric patients: A randomized, double-blind, controlled study. Chest, 125(1), 315-321.

Paut et al. (2001). EMLA versus nitrous oxide for venous cannulation in children. Anesth Analg, 93, 590-593.

Hee, Goy & Ng. (2003). Effective reduction of anxiety and pain during venous cannulation in children: a comparison of analgesic efficacy conferred by nitrous oxide, EMLA and combination. Paediatric Anasthesia, 13, 210-216.

Abdelkefi et al., (2004). Effectiveness of fixed 50% nitrous oxide oxygen mixture and EMLA cream for insertion of central venous catheters in children. Pediatr Blood Cancer, 43, 777-779.

Williams, et al. (2006). Inhaled nitrous oxide during painful procedures: a satisfaction survey. Paediatric Nursing, 18(8), 31-33.

Paris, France

Marseilles, France


Tunsia, North Africa


, UK



No NPO requirements



Consider nitrous oxide/oxygen for procedures which would likely cause mild to moderate pain and/or produce anxiety or distress, including but limited to:

Bladder catheterization (VCUG)

Peripheral IV start (PIV)

Blood draws

Peripherally inserted central catheter (PICC) placement

Nasogastric (NG) tube insertion

Gastrostomy/GJ tube change

Lead placement for EEG

CT scans

Incision and drainage (I & D)

Lumbar puncture (LP)

Joint injection

Barium enema


Wound debridement

Dressing changes

Fracture reduction, reduction dislocation

Joint injection

Foreign body removal

Removal of plaster/suture




including any condition where air may be trapped in the body:

Unresolved pneumothorax

Bowel obstruction

Air embolism




Maxillofacial injuries with potential for trapped gas

Intraocular surgery (involving injected gas in last 10 weeks)

Penetrating injury to the globe of the eye

Craniotomy in past 3 weeks unless imaging shows no free air

Decompression sickness (consider exclusion if diving in last 24 hrs




Increased intracranial pressure

Impaired level of consciousness


Vitamin B12 deficiency

Treatment with



Intoxication with drugs or alcohol


Tiered level of training


Maurine Clark






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