Presentations text content in 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
Slide2Properties 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
Slide3Determining nursing scope of practice
Documents provided by the WA State Nursing Commission
:
Slide4Clinical Trials
Zier
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
Slide5Faroux
et al. (2004). The efficacy of premixed nitrous oxide and oxygen for
fiberoptic
bronchoscopy
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
Singapore
Tunsia, North Africa
Wolverhampton
, UK
Slide6Indications
No NPO requirements
Slide7Procedures
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
Suturing
Wound debridement
Dressing changes
Fracture reduction, reduction dislocation
Joint injection
Foreign body removal
Removal of plaster/suture
Slide8Contraindications
Contraindications
including any condition where air may be trapped in the body:
Unresolved pneumothorax
Bowel obstruction
Air embolism
Severe
bullous
emphysema
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
)
Other
Contraindications:
Increased intracranial pressure
Impaired level of consciousness
Pregnancy
Vitamin B12 deficiency
Treatment with
bleomycin
sulfate
Intoxication with drugs or alcohol
Slide9Tiered level of training
Slide10Maurine Clark
maurineclark@msn.com
www.ouchlesshealthcare.org
Slide11Slide12Slide13Slide14Slide15
Maurine Clark, RN, MN, CRNI
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