Intranasal drug administration

[letmesleep]

We were sitting around the station this morning, and a conversation about IN (intranasal) administration came up. I'm wondering how many of you use this? Is it effective for you? What drugs do you administer this way? As well as, what are your thoughts?

We have searched for info about this topic, and are going to write up a proposal to Med Control, but we were looking for some "first hand knowledge" on this issue.

thanks!

[p3medic]

Our BLS crews, and ALS for that matter have the option for narcan IN. We are currently discussing utilizing the IN route for Midaz as well. I like the idea of no needle. We have used narcan via the IN route for some time now with great results.

[firedoc5]

One med that I'm sure no one carries is Stadol. Between migraines and kidney stones, I'd used Stadol NS for a while. Now I don't even want to see the box it come in.

I personally have never adm. anything IN before. It was once discussed when someone asked if you could administer the N.A.V.E.L. drugs IN. instead of down the ET. I really wasn't for sure, but I argued, Why? If you had them intubated, why go nasally? Plus, unless it's a mist form, that's a lot of fluid going into the sinus's and down the back of the throat.

Refresher:

N- Narcan

A- Atropine

V- Valium

E- Epi.

L- Lidocaine

[letmesleep]

I'd have to agree that if a Pt is intubated, IN medication is a little ridiculous in my opinion. What we have found is a device that attaches to your lur-loc type syringe, and when injected it causes a misting action. We also have found that doses have to be condensed (for lack of a better word) into a 1cc (I believe, have to find it again)amount

[zzyzx]

IN administration of certain drugs works great if you're using an atomizer. I gave Versed IN at my old service. Unfortunately, the place I work now doesn't have IN drug admin in its protocols. I recently had a 90 y/o in status seizure and could not get an IV on him. I brought him into the ER still seizing. Not good. If I could have given Versed IN, it would have stopped his seizure almost as quickly as IVP (and much faster than IM).

[fireflymedic]

Firedoc,

As far as drugs being able to be given down the tube - valium is no longer being given down the tube as it is oil based so the new acronymn being taught is LEAN (lidocaine, epi, atropine, narcan). I'm not sure if versed could be given via ET tube as I've never given it that way.

As far as giving drugs intranasal, the best method of administration by far is the MAD devices. They are fantastic ! I've done versed, narcan, and stadol that way. Works great and definitely beats rectal administration anyday ! Only issue I've found with IN administration is that some of the drug occasionally drains down the back of the throat, obviously has a bitter taste and may cause vomiting, so just be prepared for that. I'm fortunate our service carries the MAD devices, so I've never had to give IN via syringe and cath (please do so without the needle !) but I could see it given that way.

[letmesleep]

LOL....ok, sorry, I should have clarified that statement. the device we found would fit on the syringe, but replace any needle. I guess it would be like teaching someone new to administer a drug rectally.......remind them that the needle gets REMOVED. Another drug we discussed this am was maybe ATIVAN OR HALDOL for the violent psychs that are such a hot topic right now, any input on IN sedation?

[fireflymedic]

I know ativan can be given rectally, so my assumption would be that IN would be fine as well, however, I've only had experience with versed which I am definitely preferable to as I am most comfortable with it. I have used ativan in other situations, but only IV, so that's where my expertise ends sorry. As far as using it to sedate psychs, if you can control the head well enough to get a good administration, and are able to turn them or handle the vomiting issue, go for it. IN is a faster method of absorbtion than IM, so that's a definite benefit there ! I like to restrain psychs via spider straps on a backboard 'cause I think it gives me the best and safest form of restraint which I can justify. Good luck !

[jmp6753]

We currently give Narcan IN using an atomizer. Works as well and as fast as IV. I love not having a needle out when dealing with potentially violent patients.

[Shells]

My medical control is looking at adding this to our current protocols...all the responses have been great