What are Common Administration Routes For Naloxone BLS?

Witnessing an opioid overdose can be harrowing, but immediate action can save lives. Naloxone, a necessary medication in these critical moments, can halt the life-threatening effects of an overdose if administered promptly and correctly. This guide demystifies naloxone use in Basic Life Support (BLS) scenarios, equipping you with the knowledge to act decisively and effectively.

Naloxone Training: Essential Program for Life-Saving Skills.

What are the Most Commonly Used Administration Routes for Naloxone in Emergencies?

In emergency situations involving opioid overdose, naloxone can be administered through two main routes, both offering advantages for fast and effective reversal:

1. Intranasal (Nasal Spray): This is the preferred method for most bystanders and first responders in BLS due to its simplicity and quick absorption. The naloxone spray is delivered directly into each nostril of the person experiencing the overdose.
2. Intramuscular (Injection): Naloxone can also be administered as an injection into a muscle, typically the thigh or upper arm. This method may be used more frequently by medical personnel due to their training and familiarity with injectable medications.

Here’s a quick comparison:

Regardless of the route chosen, you need to follow the specific instructions provided with the naloxone device and administer it only if you or someone you are with has been trained in its proper use.

Administration of Naloxone by Intramuscular (IM) Route

Naloxone administered intramuscularly (IM) is often used by medical personnel because of their training in injection techniques. If you are trained in naloxone administration, here is the process, but remember: only administer naloxone if you or someone you are with has been trained in its proper use.

Here’s a step-by-step guide to administering IM Naloxone:

1. Gather supplies: You will need the syringe or prefilled vial of naloxone and needle (depending on the kit), alcohol swabs, and personal protective equipment (gloves, mask, eye protection), if available.
2. Prepare the injection site: Choose a large muscle such as the outer thigh (vastus lateralis) or upper arm (deltoid). Clean the chosen area with an alcohol swab in a circular motion, allowing it to dry completely.
3. Prepare the medication: If using a prefilled syringe, follow the specific instructions for activation. For a vial and needle combination, you should draw the drug from the vial into the syringe using aseptic technique (to avoid contamination).
4. Administer the injection: With the dominant hand, hold the syringe like a dart and pinch the injection site with the non-dominant hand (creating a tent). Pierce the clean area with a quick, sure motion at a 90-degree angle.
5. Inject the medication: Slowly depress the plunger of the syringe to inject the naloxone medication. Once empty, safely remove the needle from the injection site using a sharps container, if available.
6. Monitor the person: After giving naloxone, stay with the person and monitor his or her breathing and responsiveness. Call emergency services immediately, even if the person starts to wake up.

Remember that naloxone is not a substitute for professional medical care, so it is essential that emergency services be called, even if the person appears to be recovering. Administration of naloxone by injection should be done only by trained persons. If you are unsure how to administer it correctly, it is best to use nasal spray, if available, and call 911 emergency services immediately.

5 Steps to Follow for Intranasal Naloxone Administration

Administering naloxone as follows:

1. Prepare the spray: remove the naloxone nasal spray from its box. Follow the specific instructions provided with the device to activate it, if necessary.
2. Position the person: Tilt the person’s head back slightly.
3. Position the spray: gently insert the tip of the nozzle into a nostril. Point the tip toward the bridge of the nose.
4. Administer the dose: press the plunger firmly and completely to deliver a dose of naloxone. You may hear a clicking sound.
5. Repeat if necessary: some naloxone devices require a second dose in the other nostril after 2 to 3 minutes if the person does not respond. Follow device-specific instructions.
   Stay with the person: monitor the person’s breathing and responsiveness.

Equipment Needed for Intravenous Administration

Intravenous (IV) administration of naloxone is typically performed by medical professionals in emergency situations. Here’s the equipment needed:

• Small volume of sterile saline solution
• Syringe (usually 10 mL)
• I.V. administration set (tubing, needle, and butterfly needle)
• Alcohol swabs
• Tourniquet
• Naloxone medication (vial)

Difference in Time to Action Between Different Routes of Administration of Naloxone

Here’s the breakdown of how the time of action differs for naloxone depending on the administration route:

• Intravenous (IV): This offers the fastest onset of action, within 1-2 minutes. Due to the medication entering the bloodstream directly, it reaches the receptors quickly.
• Intramuscular (IM) and Subcutaneous (SC): These injections take 2-5 minutes to take effect. Naloxone needs to be absorbed into the bloodstream first, leading to a slightly slower response compared to IV.
• Intranasal (Nasal Spray): This is a common method for layperson use. Onset of action occurs within 3-5 minutes. While slower than IV, it’s a practical option in emergencies.

Safety Considerations to be Taken Into Account when Administering Naloxone in a BLS Setting

Here are some key safety considerations for administering naloxone in a BLS (Basic Life Support) setting:

Patient Assessment

• Scene safety: Ensure the scene is safe for yourself and the patient before approaching.
• Opioid overdose signs: Look for signs of opioid overdose such as respiratory depression (slow or shallow breathing or no breathing), pinpoint pupils, and decreased level of consciousness (unresponsive or difficult to awaken).
• Alternative causes: Consider other potential causes of unconsciousness besides opioid overdose.

Naloxone Administration

• Follow protocols: Administer naloxone according to your local BLS protocols and training.
• Correct dosage: Use the recommended dosage for your specific naloxone format (nasal spray, prefilled syringe, etc.).
• Route of administration: In BLS, naloxone is typically administered intranasally (nasal spray) due to its ease of use and effectiveness.
• Repeat dosing: If the patient doesn’t respond within a few minutes after the first dose, consider administering a second dose according to your protocols.

Post-administration care

• Maintain airway: Open the airway and ensure proper breathing.
• Monitor vital signs: Monitor the patient’s breathing, pulse, and oxygen levels.
• Positioning: Place the patient in a recovery position (on their side) if they are breathing.
• Seek medical attention: Call emergency services (911 or local equivalent) immediately after administering naloxone.
• Patient safety: Stay with the patient and monitor them until medical help arrives.

Precautions you Should Take when Administering Naloxone to a Critically ill Patient

Here are some key precautions to take after administering naloxone to a critically ill person:

Monitor for Reversal

• Respiratory status: Closely monitor the person’s breathing after administering naloxone. Look for signs of improvement such as increased respiratory rate and depth.
• Level of consciousness: Observe if the person regains consciousness or shows signs of becoming more alert.

Potential for Repeated Doses

• Opioid dependence: If the person is dependent on opioids, naloxone can reverse the effects and trigger withdrawal symptoms. Be prepared to administer additional doses of naloxone if breathing remains depressed after the initial dose, following your local protocols.

Underlying Medical Conditions

• Don’t assume overdose: Naloxone reverses opioid overdoses, but it’s important to remember that the person might be unconscious due to other medical conditions.

Medical Attention 

• Call emergency services (911 or local equivalent) immediately after administering naloxone, regardless of the person’s response.
• Explain the situation: Inform emergency personnel that you suspect an opioid overdose and have administered naloxone.
• Continued monitoring: Stay with the person and continue monitoring their breathing and level of consciousness until medical help arrives.

Legal and Safety Aspects

Good Samaritan laws in many areas protect individuals who administer naloxone in an attempt to save lives. Familiarizing yourself with local laws and maintaining safety are paramount.

Naloxone as a Necessary Tool in the Fight Against Opioid Overdoses

Naloxone represents hope and a second chance for individuals experiencing an opioid overdose. Its proper administration is a vital skill in today’s world, where opioid-related incidents continue to rise. By understanding and applying naloxone, you can become an integral part of the solution, potentially saving lives and fostering a safer community.