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Maurine Clark, RN, MN, CRNI maurineclark@msn.com www.ouchlesshealthcare.org April 21, 2012 PowerPoint Presentation
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The Ouchless Hospital Developing a Nurse Administered Nitrous Oxide Program Using research, current guidelines and the voices of children. Maurine Clark, RN, MN, CRNI maurineclark@msn.com www.ouchlesshealthcare.org April 21, 2012 Society of Pediatric Nurse 22 nd Annual Convention

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The Ouchless Hospital

Developing a Nurse Administered Nitrous Oxide Program

Using research, current guidelines and the voices of children

Maurine Clark, RN, MN, CRNI

maurineclark@msn.com

www.ouchlesshealthcare.org

April 21, 2012

Society of Pediatric Nurse 22nd Annual Convention

Houston, Texas

properties of n2o o2
Properties of N2O/O2
  • Anxiolytic
  • Analgesic
  • Amnestic
  • Minimal sedation
  • Patient remains awake and able to respond
  • Rapid onset, rapid recovery
  • Not metabolized
  • Delivered with oxygen (reversal agent)
  • Fail safe equipment
  • Phenomenal safety record
determining nursing scope of practice
Determining nursing scope of practice
  • Documents provided by the WA State Nursing Commission:
clinical trials
Clinical Trials

Zier et al. (2007). Case-series of nurse-administered nitrous oxide for urinary catheterization in children. Anesthesia & Analgesia, 109(4), 876-879.

Minnesota, USA

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.

Sydney, Australia

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

Melbourne, Australia

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

Melbourne, Australia

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Faroux et al. (2004). The efficacy of premixed nitrous oxide and oxygen for fiberopticbronchoscopy in pediatric patients: A randomized, double-blind, controlled study. Chest, 125(1), 315-321.

Paris, France

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

Marseilles, France

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. PaediatricAnasthesia, 13, 210-216.

Singapore

Tunsia, North Africa

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.

Wolverhampton, UK

indications
Indications

No NPO requirements

procedures
Procedures
  • 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
contraindications
Contraindications

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
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Maurine Clark

maurineclark@msn.com

www.ouchlesshealthcare.org